Age and Tumor Location Predict Survival in Nonmetastatic Osteosarcoma in Upper Egypt.

AIM: The aims of this study were to assess survival outcome of pediatric patients with localized osteosarcoma of the extremities in Upper Egypt, identify factors of prognostic significance for survival, and to determine factors predictive of surgical methods used in these patients, as well as developing a clinical model for risk prediction. PATIENTS AND METHODS: A retrospective analysis of data assembled from medical records of 30 pediatric patients with a histologically verified nonmetastatic osteosarcoma of the extremities treated at South Egypt Cancer Institute with a unified chemotherapy protocol between January 2001 and December 2015 was carried out. Prognostic factors were determined using univariable and multivariable methods. A model for surgical outcomes in these patients based on the baseline clinical factors, and the parameters predictive of their tumor response to chemotherapy, was developed. RESULTS: With a median follow-up of 63 months for the study population, the estimates for event-free survival and overall survival (OS) at 3 and 5 years were 69.5% and 79% and 65.2% and 65.3%, respectively. Age 16 years or above was independently associated with both worse metastasis-free survival (hazard ratio [HR]=6.05, 95% confidence interval [CI]: 1.43-25.6, P=0.015) and OS (HR=7.9, 95% CI: 1.71-36.2, P=0.008). In the multivariable analysis, a proximal location within the limb gained a statistical significance to be independently associated with worse OS (HR=2.4, 95% CI: 1.13-22.1, P=0.003). Poor response to chemotherapy was marginally associated with worse metastasis-free survival (HR=4.9, 95% CI: 1.02-23.8, P=0.047) only in the univariable analysis. The patients found to be more likely to undergo an amputation surgery (odds ratio=14.1, 95% CI: 1.34-149.4, P=0.028) were those in whom a tumor was poorly responding to chemotherapy. CONCLUSION: In Upper Egypt, despite the reasonable survival outcomes in nonmetastatic osteosarcoma, a relatively high limb amputation rate has been encountered. The development of a clinical prediction model for future planning of possible outcome improvement in these patients, however, is still feasible.

Pediatric Osteosarcoma of Extremities: A 15-year Experience From a Tertiary Care Cancer Center in Upper Egypt.

AIM: To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a 15-year period. MATERIALS AND METHODS: We performed a retrospective analysis of medical records of 48 pediatric patients with histologically verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. RESULTS: With a median follow-up of 61 months for the entire cohort, estimates of overall survival (OS) for 3- and 5-year were 50.9% and 42.1%, respectively. While the estimates of OS for 3- and 5-year in the nonmetastatic group were 79% and 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for event-free survival. Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, while a poor response to chemotherapy became marginally associated with an inferior outcome. CONCLUSIONS: In Upper Egypt, whereas slightly less than two thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.

Serotypes of Streptococcus pneumoniae in Egyptian children: are they covered by pneumococcal conjugate vaccines?

In Egypt, pneumococcal vaccines have not yet been introduced as being compulsory. Identification of the circulating serotypes in Egypt is mandatory to determine whether or not the pneumococcal vaccines will be beneficial. The current study aims to identify the serotypes, vaccine coverage, and antimicrobial resistance of Streptococcus pneumoniae colonizing the nasopharynx of Egyptian children younger than 5 years old. The study was conducted in two successive winter seasons (December 2012-February 2013 and December 2013-February 2014). Two hundred children were enrolled, aged from 6 months to 5 years, excluding those with fever, signs of infection, history of antibiotic intake, and hospitalization in the preceding month. Nasopharyngeal (NP) secretions were collected, subjected to culture, and underwent antibiotic susceptibility testing if positive for pneumococci. Real-time polymerase chain reaction (PCR) and serotyping by sequential multiplex PCR for positive cases were included as well. Streptococcus pneumoniae was isolated from 62 subjects. All isolates were sensitive to vancomycin and levofloxacin, but the majority showed resistance to multiple antibiotics. PCR was positive for pneumococci in 113 subjects (56.5%). The most commonly detected serotypes (st) were 6A6B6C (n = 21, 20.8%), 19F (n = 19, 18.8%), 1 (n = 11, 10.9%), 34 (n = 8, 7.9%), and 19A (n = 6, 5.9%). The theoretical coverage of the PCV13 vaccine for the detected serotypes was 72.4%, while that of PCV10 was 65.5%. Based on these percentages, we recommend including pneumococcal conjugate vaccines in the Egyptian national vaccination program.

Association between hospital procedure volume and risk of revision after total hip arthroplasty: a population-based study within the Nordic Arthroplasty Register Association database.

OBJECTIVE: Outcome after total hip arthroplasty (THA) depends on several factors related to the patient, the surgeon and the implant. It has been suggested that the annual number of procedures per hospital affects the prognosis. We aimed to examine if hospital procedure volume was associated with the risk of revision after primary THA in the Nordic countries from 1995 to 2011. DESIGN: The Nordic Arthroplasty Register Association database provided information about primary THA, revision and annual hospital volume. Hospitals were divided into five volume groups (1-50, 51-100, 101-200, 201-300, >300). The outcome of interest was risk of revision 1, 2, 5, 10 and 15 years after primary THA. Multivariable regression was used to assess the relative risk (RR) of revision. RESULTS: 417,687 THAs were included. For the 263,176 cemented THAs no differences were seen 1 year after primary procedure. At 2, 5, 10 and 15 years the four largest hospital volume groups had a reduced risk of revision compared to group 1-50. After 10 years RR was for volume group 51-100 0.79 (CI 0.65-0.95), group 101-200 0.76 (CI 0.61-0.95), group 201-300 0.74 (CI 0.57-0.96) and group >300 0.57 (CI 0.46-0.71). For the uncemented THAs an association between hospital volume and risk of revision were only present for hospitals producing 201-300 THAs per year, beginning at years 2 through 5 and in all subsequent time intervals to 15 years. CONCLUSION: Hospital procedure volume was associated with a long term risk of revision after primary cemented THA. Hospitals operating 50 procedures or less per year had an increased risk of revision after 2, 5, 10 and 15 years follow up.

Chemotherapy Alone for Patients With Stage II/III Rectal Cancer Undergoing Radical Surgery.

PURPOSE: The purpose of this prospective pilot study was to determine the efficacy of preoperative chemotherapy with six cycles of FOLFOX 6 (without radiation therapy) followed by radical surgery followed by six additional cycles of FOLFOX 6 for patients with stage II/III rectal cancer. PATIENTS AND METHODS: From January 2010 to January 2014, patients with locally advanced rectal cancer who met the eligibility criteria were enrolled in this study. Patients received FOLFOX 6 chemotherapy comprising oxaliplatin and leucovorin calcium i.v. over 2 hours on day 1, then bolus, and then continuous fluorouracil i.v. over 46 hours on days 1 and 2. Treatment was repeated every 14 days for 6 courses followed by radical surgery followed by additional 6 cycles of FOLFOX 6. RESULTS: In total, 45 patients were enrolled in this study. In the preoperative re-evaluation, the overall response rate was 68.8% (clinical complete response was 4.4%, and the partial response was 64.4%). There were 14 cases (31.2%) of stable disease. No patients had progressive disease. Postoperatively, the pathologic complete response rate was 8 of 45 (17.8%; 95% confidence interval [CI]: 8.9%-28.9%). The median follow-up was 29 months (range 9-54 months). The actuarial 3-year overall survival and disease-free survival rates for all patients were 80.8% (standard error, 1.877; 95% CI: 69.3%-92.3%) and 67.9% (standard error, 2.319; 95% CI: 54.3%-81.5%), respectively. CONCLUSION: Neoadjuvant chemotherapy (FOLFOX) without radiotherapy is active and safe but cannot be considered a standard of care until the results of prospective randomized phase III trials are available. IMPLICATIONS FOR PRACTICE: Neoadjuvant radiotherapy of rectal cancer represents the current standard of care. However, its use is also associated with short-term toxicity and long-term morbidity. With the increasing use of total mesorectal resection resulting in better local control and advances in systemic therapy for colorectal cancer, this study highlights the question of whether radiation is a necessary component of neoadjuvant therapy for all patients with rectal cancer or whether select patients could be spared the additional toxicities and inconvenience of radiotherapy. This study suggests that neoadjuvant FOLFOX without radiotherapy is active and safe, but it could not be considered a standard of care till now.

Towards Internet QoS provisioning based on generic distributed QoS adaptive routing engine.

Increasing efficiency and quality demands of modern Internet technologies drive today's network engineers to seek to provide quality of service (QoS). Internet QoS provisioning gives rise to several challenging issues. This paper introduces a generic distributed QoS adaptive routing engine (DQARE) architecture based on OSPFxQoS. The innovation of the proposed work in this paper is its undependability on the used QoS architectures and, moreover, splitting of the control strategy from data forwarding mechanisms, so we guarantee a set of absolute stable mechanisms on top of which Internet QoS can be built. DQARE architecture is furnished with three relevant traffic control schemes, namely, service differentiation, QoS routing, and traffic engineering. The main objective of this paper is to (i) provide a general configuration guideline for service differentiation, (ii) formalize the theoretical properties of different QoS routing algorithms and then introduce a QoS routing algorithm (QOPRA) based on dynamic programming technique, and (iii) propose QoS multipath forwarding (QMPF) model for paths diversity exploitation. NS2-based simulations proved the DQARE superiority in terms of delay, packet delivery ratio, throughput, and control overhead. Moreover, extensive simulations are used to compare the proposed QOPRA algorithm and QMPF model with their counterparts in the literature.

Surgical Outcomes of Laparoscopic-assisted Distal Gastrectomy Versus Totally Laparoscopic Distal Gastrectomy Billroth I for Gastric Cancer.

OBJECTIVE: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.

Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study. / Dosis de radiación durante la inserción guiada por fluoroscopia de un dispositivo de acceso venoso central: un estudio observacional retrospectivo.

INTRODUCTION: Central venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps. MATERIAL AND METHODS: A retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n=24) and 7.5 pps (n=33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye. RESULTS: The results show that the median dose area product (DAP) for CVAD insertion is 0.7Gy.cm2 and 0.3Gy.cm2 for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36µSv, 0.1µSv and 0.05µSv when 7.5 pps was utilised and 0.13µSv, 0.03µSv and 0.02µSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1µSv, 1.4µSv, and 0.6µSv in the 7.5 pps studies and 0.7µSv, 0.5µSv, and 0.2µSv when 4pps was used. CONCLUSION: The patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.

Telocyte and Cajal cell distribution in renal pelvis, ureteropelvic junction (UPJ), and proximal ureter in normal upper urinary tract and UPJ obstruction: reappraisal of the aetiology of UPJ obstruction.

BACKGROUND: Telocytes and Cajal cells have been described in human urinary tract and reproductive system in women and men. Telocytes and Cajal cells have been differentiated from other interstitial cells and were described to be an element in smooth muscle conductivity. Previous studies examined the ureteropelvic junction (UPJ) segment in patients with UPJ obstruction (UPJO) and attributed the aetiology of UPJO to the low density or absence Cajal cells and telocytes. The present work aimed at the demonstration of the presence and the density of telocytes and Cajal cells in the upper urinary tract (UUT) in cases with normal UUT and UPJO. It included UPJ segment, renal pelvis, and proximal ureter. The morphological pattern of distribution of collagen in relation to smooth muscle was investigated in normal and obstructed UUT. MATERIALS AND METHODS: The study was carried out on 12 surgical specimens, 5 of them represented the normal UUT and underwent nephrectomy for oncological reasons. Seven patients underwent dismembered pyeloplasty for UPJO. Surgical specimens included renal pelvis, UPJ segment, and proximal ureter. They were subjected to standard haematoxylin and eosin stain, Gomori's trichrome stain, immunohistochemistry with c-kit, and transmission electron microscopy. RESULTS: Telocytes and Cajal cells were demonstrated in the muscular layer of both normal UUT and UPJO with high density in the proximal ureter in normal UUT as well as in UPJO. The UPJ segment in normal UUT had moderate density of Cajal cells and telocytes while in UPJO the cells were scanty or absent. Renal pelvis in normal UUT showed excess density of cells while obstructed renal pelvis showed scanty Cajal cells and telocytes. Ultrastructural study showed the presence of Cajal cells, telocytes, stem cells, fibroblasts, smooth muscle cells, and collagen in different densities and distribution in normal and obstructed UUT. CONCLUSIONS: Examination of the UPJ segment of UPJO revealed that Cajal cells and telocytes were scanty or absent, collagen to muscle ratio was high. The low density of Cajal cells and telocytes in the renal pelvis of the obstructed UUT, compared to the normal, points out to the role of the renal pelvis in the pathogenesis of UPJO.

A multiparametric MRI-based CAD system for accurate diagnosis of bladder cancer staging.

Appropriate treatment of bladder cancer (BC) is widely based on accurate and early BC staging. In this paper, a multiparametric computer-aided diagnostic (MP-CAD) system is developed to differentiate between BC staging, especially T1 and T2 stages, using T2-weighted (T2W) magnetic resonance imaging (MRI) and diffusion-weighted (DW) MRI. Our framework starts with the segmentation of the bladder wall (BW) and localization of the whole BC volume (Vt) and its extent inside the wall (Vw). Our segmentation framework is based on a fully connected convolution neural network (CNN) and utilized an adaptive shape model followed by estimating a set of functional, texture, and morphological features. The functional features are derived from the cumulative distribution function (CDF) of the apparent diffusion coefficient. Texture features are radiomic features estimated from T2W-MRI, and morphological features are used to describe the tumors' geometric. Due to the significant texture difference between the wall and bladder lumen cells, Vt is parcelled into a set of nested equidistance surfaces (i.e., iso-surfaces). Finally, features are estimated for individual iso-surfaces, which are then augmented and used to train and test machine learning (ML) classifier based on neural networks. The system has been evaluated using 42 data sets, and a leave-one-subject-out approach is employed. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve (AUC) are 95.24%, 95.24%, 95.24%, and 0.9864, respectively. The advantage of fusion multiparametric iso-features is highlighted by comparing the diagnostic accuracy of individual MRI modality, which is confirmed by the ROC analysis. Moreover, the accuracy of our pipeline is compared against other statistical ML classifiers (i.e., random forest (RF) and support vector machine (SVM)). Our CAD system is also compared with other techniques (e.g., end-to-end convolution neural networks (i.e., ResNet50).

Ischemia-modified Albumin as a Biomarker for Prediction of Poor Outcome in Patients With Traumatic Brain Injury: An Observational Cohort Study.

BACKGROUND: Biomarkers can assist in outcome prediction and therapeutic decision making after traumatic brain injury (TBI). The aim of this study was to evaluate the role of ischemia-modified albumin (IMA) in the prediction of mortality in patients with TBI. METHODS: In this observational study IMA was measured on admission to intensive care unit (D0) and 24 hours later (D1) in a cohort of patients with mixed TBI severity. The primary outcome was the correlation between IMA and 28-day mortality. Secondary outcomes included the incidence of elevated IMA, and the correlation between the severity of TBI and IMA, and between IMA and change in Glasgow coma score (GCS). The area under receiver operating characteristic curve analysis was performed to detect optimal IMA cut-off value for the detection of mortality. RESULTS: Fifty-four patients were included in the study; IMA was elevated in 49 (90.7%) on admission to the intensive care unit. Of the 49 patients with elevated IMA, 22 had a decrease in IMA while 27 had an increase by 24 hours. IMA levels were higher at D0 and D1 (P<0.001 for both) in patients who died compared with those who survived. Twenty-one patients died (mortality rate 38.9%); all had elevated IMA on D0 and D1 and higher IMA levels at D1 compared with D0. Optimal cut-off values for IMA predicted mortality with 76.2% sensitivity and 81.8% specificity at D0 and with 100% sensitivity and specificity at D1. IMA values at D0 and D1 were correlated with D0 and D1 GCS, respectively (both P<0.001). CONCLUSION: IMA levels were elevated in patients following TBI, and can predict mortality with high sensitivity and specificity.

Integrated treatment of olive mill wastewater (OMW) by the combination of Fenton's reaction and anaerobic treatment.

The use of an integrated treatment scheme consisting of wet hydrogen peroxide catalytic oxidation (WHPCO) followed by two-stage upflow anaerobic sludge blanket (UASB) reactor (10l each) for the treatment of olive mill wastewater was the subject of this study. The diluted wastewater (1:1) was pre-treated using Fenton's reaction. Optimum operating conditions namely, pH, H(2)O(2) dose, Fe(+2), COD:H(2)O(2) ratio and Fe(+2):H(2)O(2) ratio were determined. The UASB reactor was fed continuously with the pre-treated wastewater. The hydraulic retention time was kept constant at 48h (24h for each stage). The conventional parameters such as COD, BOD, TOC, TKN, TP, TSS, oil and grease, and total phenols were determined. The concentrations of polyphenolic compounds in raw wastewater and effluents of each treatment step were measured using HPLC. The results indicated a good quality final effluent. Residual concentrations of individual organic compounds ranged from 0.432 mg l(-1) for rho-hydroxy-benzaldhyde to 3.273 mg l(-1) for cinnamic acid.

Assessment of the Diagnostic Potential of miR-29a-3p and miR-92a-3p as Circulatory Biomarkers in Acute Myeloid Leukemia.

BACKGROUND: Acute myeloid leukemia (AML) is a set of Myeloproliferative neoplasms that are identified by excessive growth of myeloid blasts and production of abnormal blood cells. AML is the most common type of acute leukemia that occurs in adults. In addition, AML progresses rapidly and is considered a fatal disease. Thus, there is an urgent need to find new targets for molecularly designed therapies. In This study, we evaluated the circulatory levels of microRNA-29a-3p (miR-29a-3p) and miR-92a-3p beside exploring the expression pattern of their target gene myeloid cell leukemia sequence1 (MCL1) to investigate the role of these molecules in AML pathophysiology and to assess their ability to diagnose AML patients. METHODS: 40 adult AML patients along with 20 healthy subjects were enrolled in this study. Plasma were separated from venous blood samples, collected on EDTA, of all individuals were used to assess circulating miRNAs' levels. In the meantime, total RNA was extracted from isolated leukocytes and was used to quantify target mRNA transcript levels. RESULTS: Our data revealed that the circulating levels of miR-29a-3p and miR-92a-3p exhibited significant reduction in 90% and 100% of AML patients, respectively, when compared to the control group (p<0.001). On the other hand, the transcript level of the target gene of these miRNAs, MCL1, showed a sharp increase in 77.5% (p<0.001) of AML patients, along with a negative correlation with its regulatory miRNAs, miR-29a-3p and miR-92a-3p. CONCLUSION: Our data validates the negative regulatory role of miR-29a-3p and miR-92a-3p to the expression levels of MCL1 in peripheral blood and indicates that these miRNAs can be used as non-invasive diagnostic markers. Furthermore, our study highlights the therapeutic potential of miR-29a-3p and miR-92a-3p to target and downregulate a very important gene (MCL1), which is highly implicated in the pathogenesis of AML.

EARLY ASSESSMENT OF RENAL TRANSPLANTS USING BOLD-MRI: PROMISING RESULTS.

Non-invasive evaluation of renal transplant function is essential to minimize and manage renal rejection. A computer-assisted diagnostic (CAD) system was developed to evaluate kidney function post-transplantation. The developed CAD system utilizes the amount of blood-oxygenation extracted from 3D (2D + time) blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) to estimate renal function. BOLD-MRI scans were acquired at five different echo-times (2, 7, 12, 17, and 22) ms from 15 transplant patients. The developed CAD system first segments kidneys using the level-sets method followed by estimation of the amount of deoxyhemoglobin, also known as apparent relaxation rate (R2*). These R2* estimates were used as discriminatory features (global features (mean R2*) and local features (pixel-wise R2*)) to train and test state-of-the-art machine learning classifiers to differentiate between non-rejection (NR) and acute renal rejection. Using a leave-one-out cross-validation approach along with an artificial neural network (ANN) classifier, the CAD system demonstrated 93.3% accuracy, 100% sensitivity, and 90% specificity in distinguishing AR from non-rejection . These preliminary results demonstrate the efficacy of the CAD system to detect renal allograft status non-invasively.

Radiation Dose Optimization in Interventional Cardiology: A Teaching Hospital Experience.

Radiological interventions play an increasingly relevant role in cardiology. Due to the inherent risks of ionizing radiation, proper care must be taken with monitoring and optimizing the dose delivered in angiograms to pose as low risk as possible to staff and patients. Dose optimization is particularly pertinent in teaching hospitals, where longer procedure times are at times necessary to accommodate the teaching needs of junior staff, and thus impart a more significant radiation dose. This study aims to analyze the effects of different protocol settings in routine coronary angiograms, from the perspective of a large tertiary center implementing a rapid dose reduction program. Routine coronary angiograms were chosen to compare baseline levels of radiation, and the dose imparted before and after dose optimization techniques was measured. Such methods included lowering dose per pulse, fluoroscopic pulse rates, and cine acquisition frame rates. The results showed up to 63% reduction in radiation dose without adverse impact on clinical or teaching outcomes. A 10 fps/low and 5 pps/low setting was found to achieve maximum dose optimization, with the caveat that settings require incremental changes to accommodate for patient complexities.

T-lymphocyte subsets and thymic size in malnourished infants in Egypt: a hospital-based study.

Thymus size was assessed ultrasonographically and correlated to the percentage of CD4 and CD8 T-lymphocytes in peripheral blood in 32 infants with protein-energy malnutrition (PEM) and compared with 14 healthy control infants. The study revealed thymus atrophy in patients with PEM, especially the oedematous type, accompanied by changes in the peripheral lymphocyte subsets. These changes were reversible after nutritional rehabilitation. However, they may affect the immune status of PEM patients and may require a longer duration of nutrition rehabilitation than required for recovery of anthropometric measures. We recommend proper assessment of the immune functions of PEM patients during nutritional rehabilitation until full recovery.

Fenton's peroxidation and coagulation processes for the treatment of combined industrial and domestic wastewater.

As a consequence of the population growth, major efforts have been made by the Egyptian government to construct new industrial areas. Tenth of Ramadan City is one of the most important industrial cities in Egypt. The wastewater generated from various industrial activities was highly contaminated with organic matters as indicated by COD (1750-3323 mg/L), TSS (900-3000 mg/L) and oil and grease (13.2-95.5 mg/L). All overall appraisals of the analytical data from the industrial wastewater indicate that pretreatment is required for all industrial sectors to achieve compliance with the Egyptian Environmental law which requires effective pretreatment of industrial wastewater prior to its discharge into public sewers. Treatability studies via conventional and Fenton processes have been investigated. The efficiency of conventional treatment methods led to 63% COD and 44% color removal by using FeCl(3) as coagulant. Various coagulant aids and powdered activated carbon (PAC) were added to 400mg/L FeCl(3) in order to enhance the removal of color. It was found that polyacrylamide polymer, bentonite and PAC increased the efficiency of the treatments where the color removal increased to 79%, by cationic polymer, 73% by anionic polymer, 84.5% by bentonite and 95% for 0.4 g/L PAC. Fenton process was investigated which under the operating conditions (pH 3.0+/-0.2, Fe(2+) dose=400 mg/L and H(2)O(2)=550 mg/L), color removal up to 100% and more than 90% of COD removal were achieved.

DKK1 in relation to HCV induced liver cirrhosis and HCV induced HCC curative resection.

BACKGROUND: hepatitis C virus (HCV) is an RNA virus that induces hepatocarcinogenesis by mechanisms other than integration in the host cell genome. Dickkopf-1 (DKK1) expression has been studied mostly in hepatitis B virus induced HCC but not properly investigated in HCV induced HCC. AIM: Aim: we aimed to assess serum DKK1 in HCV induced HCC, HCV induced liver cirrhosis and viral infection-free controls. Moreover, we assessed serum DKK1 level after curative resection of HCC.. METHODS: Serum DKK1 was measured by ELISA in 20 HCV induced HCC patients; both pre-resection and post-resection, 20 HCV induced liver cirrhosis patients and 20 viral infection-free controls. RESULTS: DKK1 levels were significantly higher in HCC than cirrhosis patients (P = 0.000). DKK1 did not differ significantly between cirrhotic patients and controls (P = 0.11). DKK1 levels significantly reduced 5 days post-resection compared to their pre-resection levels (P = 0.000). CONCLUSIONS: We documented serum DKK1 as a marker for detection of early HCC in HCV infected patients. Significant reduction of DKK1 5 days after curative resection might indicated it as a follow up marker for recurrence in surgically resected HCV induced HCC patients. Larger scale studies to follow up its level at various intervals postoperatively and evaluate its pre-resection level as a prognostic marker in HCV induced HCC patients will be needed. (Acta gastro-enterol. belg., 2016, 79, 309-313).

Exposure to Perinatal Infections and Bipolar Disorder: A Systematic Review.

Bipolar disorder (BD) is a debilitating psychiatric disorder and a growing global public health issue. Notwithstanding BD has been conceptualized as a neuroprogressive illness, there are some evidences to suggest a role for neurodevelopmental pathways in the patho-etiology of this disorder. Evidences on the associations between perinatal infections and risk for bipolar disorder have been inconsistent across studies. Here, we performed a systematic review of observational studies on the relationship between exposure to perinatal pathogens and bipolar disorder. A computerized literature search of the PubMed, Embase, and PsyINFO databases till January 31(st), 2015 was performed. Twenty-three studies ultimately met inclusion criteria. Studies investigated exposure to several pathogens namely Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), Herpes simplex virus-1 (HSV-1), Herpes simplex virus-2 (HSV-2), Human herpesvirus 6 (HHV-6), Toxoplasma gondii, Influenza, and Varicella zoster virus (VZV). Overall, studies provided mixed evidences. Thus, contrary to schizophrenia, the role of perinatal infections as risk factors for BD remain inconclusive. Larger studies with a prospective design would be necessary to elucidate the role of previous exposure to infectious agents as a potential risk factor for BD.