Population status, habitat preferences and predictive current and future distributions of three endangered Silene species under changing climate.

One of the most crucial steps in the practical conservation of endangered endemic mountain plants is to address their population size status and habitat requirements concurrently with understanding their response to future global warming. Three endangered Silene species-Silene leucophylla Boiss., S. schimperiana Boiss., and S. oreosinaica Chowdhuri-in Egypt were the focus of the current study. These species were examined for population status change, habitat quality variables (topography, soil features, and threats), and predictive current and future distributions. To find population size changes, recent field surveys and historical records were compared. Using Random Forest (RF) and Canonical Correspondence Analysis (CCA), habitat preferences were assessed. To forecast present-day distribution and climate change response, an ensemble model was used. The results reported a continuous decline in the population size of the three species. Both RF and CCA addressed that elevation, soil texture (silt, sand, and clay fractions), soil moisture, habitat-type, chlorides, electric conductivity, and slope were among the important variables associated with habitat quality. The central northern sector of the Saint Catherine area is the hotspot location for the predictive current distribution of three species with suitable areas of 291.40, 293.10, and 58.29 km2 for S. leucophylla, S. schimperiana, and S. oreosinaica, respectively. Precipitation-related variables and elevation were the key predictors for the current distribution of three Silene species. In response to climate change scenarios, the three Silene species exhibited a gradual contraction in the predictive suitable areas with upward shifts by 2050 and 2070. The protection of these species and reintroduction to the predicted current and future climatically suitable areas are urgent priorities. Ex-situ conservation and raised surveillance, as well as fenced enclosures may catapult as promising and effective approaches to conserving such threatened species.

Establishing the Top 10 Research Priorities for Adolescent and Young Adult (AYA) Cancer in Canada: A Protocol for a James Lind Alliance Priority Setting Partnership.

Adolescents and young adults (AYAs; 15-39 years) diagnosed with cancer have unique medical and psychosocial needs. These needs could be better addressed through research that is focused on the topics that matter most to them. However, there is currently no patient-oriented research agenda for AYA cancer in Canada. This manuscript describes the early development and project protocol for a priority-setting partnership (PSP) for establishing the top 10 research priorities for AYA cancer in Canada. This project follows the PSP methodology outlined by the James Lind Alliance (JLA) to engage patients, caregivers, and clinicians in research prioritization. The steps of a JLA PSP include establishing a steering group and project partners, gathering uncertainties, data processing and verifying uncertainties, interim priority setting, and a final priority setting workshop. The AYA cancer PSP will result in a top 10 list of research priorities identified by Canadian AYA patients, caregivers, and clinicians that will be published and shared broadly with the research community. The first steering group meeting was held in April 2023, and the project is ongoing. The establishment of a patient-oriented research agenda for AYA cancer will catalyze a long-term and impactful research focus and ultimately improve outcomes for AYA patients with cancer in Canada.

Clinical Outcomes of the Liver-First Approach in the Management of Synchronous Colorectal Liver Metastases: A Retrospective Study

Abstract Introduction Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high.

Added sugar intake among the saudi population.

Diet is a contributor to the pathogenesis of many non-communicable diseases. Among contributors to poor diet is high added sugar consumption, which is unfortunately on the rise nowadays. The recommended sugar intake by The American Heart Association (AHA) is 24g/day and 36g/day for women and men, respectively. The study's aim is to assess added sugar intake among adults in Saudi Arabia. A cross-sectional study design was used via an online survey among adults in Saudi Arabia using convenience sampling, and social media platforms were used to collect the data. The authors conducted descriptive statistics to present demographic variables using Chi-square χ2 tests for categorical and t-tests for continuous variables. All statistical tests used a 95% confidence interval with a two-sided P-value <0.05 as significance level. A total of 1163 respondents were included in the study. The study has shown an overall added sugar intake average of 73 g/day. There was a significant difference in means of overall added sugar intake across genders for the age group 18-30 and the age group >60. Equivalently, there was a statistically significant difference in means of added sugar intake food across gender (P-value 0.008). Females tended to consume more added sugar in their food than males. The highest consumption was in the Northern region (123.71 g/day), followed by the Southern region (98.52 g/day), the Western region (86.14 g/day), and lastly, the Central and Eastern regions (66.95 and 62.02 g/day, respectively). The total added sugar intake of added sugar is extremely high in Saudi Arabia. Poor dietary habits lead to many adverse health consequences, including obesity and diabetes. Healthcare providers and public health officials are highly encouraged to shed light on added sugar consumption and create opportunities to promote healthy dietary patterns. The Saudi population is recommended to abide by the added sugar dietary recommendations to avoid future chronic medical conditions.

Off-Pump Versus On-Pump Coronary Artery Bypass Grafting In Patients With Left Main Coronary Artery Disease: A Randomized Controlled Trial.

Objectives: To compare the outcome of off-pump and on-pump coronary artery bypass graftsurgery in patients with left main coronary artery disease. METHODS: The randomised, controlled, prospective, multicentric study was conducted in 2020 during the period from January 2020 to December 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt, and comprised patients with left main coronary artery disease who underwent coronary artery bypass graftsurgery. The patients were randomised to on-pump surgery group I (Control Group) and off-pump surgery group II(Interventional Group). All patients were assessed pre-operatively for the presence of comorbid conditions and post-operatively for myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data was analysed using SPSS 20. RESULTS: Of the 60 patients, 44(73.3%) were men and 16(26.6%) were women. The overall mean age was 66.4±9.2 years. There were 30(50%) patients in each of the two groups. There were 2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II. There was 1(3.3%) case of acute kidney injury in group I and none in group II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in group II. There was 1(3.3%) case of sternal dehiscence in group I and none in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in group II. There was no significant difference with respect to outcome between the groups (p>0.05). CONCLUSIONS: Off-pump coronary artery bypass graft surgery was found to be efficient and non-inferior to on-pump procedure in patients with left main coronary artery disease. RCT registration: The RCT was registered retrospectively at the Pan African Clinical Trials Registry (PACTR) (Trial #: PACTR202301506140749 Date of Approval: 06/01/2023). Link: https://pactr.samrc.ac.za/Search.aspx.

Mini-Sternotomy Versus Conventional Sternotomy In Aortic Valve Replacement Surgery; A Comparative Study.

Objectives: To assess safety; efficacy and efficiency of mini-sternotomy in aortic valve replacement in comparison to conventional sternotomy on short term follow up. Method: This comparative study between 45 patients having aortic valve replacement via fullsternotomy versus 45 others planned for upper j-shaped mini-sternotomy, was conducted from May 2019 to February 2022 in Kafrelsheikh university hospital, Egypt. Data was collected and statistically analysed to assess outcomes. RESULTS: Mini-Sternotomy approach was compared to conventional approach on the aspects of cardio pulmonary bypass (CPB) (p=0.153) and cross clamp (CC) time (p=0.673),. There was significantly less postoperative bleeding (p<0.001), rate of blood transfusion (p<0.001), duration of ICU stay (p=0.013) and total hospitalstay (p=0.022) in ministernotomy approach in comparison to conventional sternotomy. CONCLUSIONS: For primary isolated AVR, lessinvasive techniques are a realistic, practical, and good alternative that offers better postoperative results than Full Sternotomy.

Effect Of Left Ventricular Hypertrophy On The Outcome Of Coronary Artery Bypass Grafting.

Objectives: To evaluate the relationship between left ventricular hypertrophy (LVH) and coronary artery bypass grafting (CABG) procedure especially on the early outcome during the first 6 months following surgical intervention. Method: This prospective cohort study included 82 patients with coronary artery disease indicating CABG. These patients were admitted, operated and followed -up in cardiothoracic surgery departmentsin the faculty of medicine, Kafrelsheikh university hospitals in the period from April 2019 till November 2021.The patients included in this study were divided into two groups according to presence or absence of left ventricular hypertrophy, Group I had 38 (46.34%) patients with LVH and Group 2 had 44 (53 .65%). patients without LVH. RESULTS: The time to regain mechanical activity waslonger (5.76±1.82) minutesin LVH patients(p <0.001). LVH group had a significantly longer period of mechanical ventilation 16.50±4.25 hours (p <0.001) compared to non LVH group which was 9.61±3.78 hours. Also, the mean duration of ICU stays in the LVH group compared to the non LVH group was 3.81±1.20 days versus 2.56±0.81 daysrespectively. The ICU follow up showed a statistically significant relationship of arrhythmias with LVH (p =0.022), infections (p =0.005) and wound infections (p<0.001). CONCLUSIONS: In patients undergoing CABG surgery, LVH has been associated with increased morbidity and poor outcome.

Effect Of Flippits Versus Virtual Reality On Pain, Fear, And Satisfaction During Phlebotomy Among Children.

Objectives: To determine the effect of flippits versus virtual reality on pain, fear and satisfaction among children during phlebotomy. Method: The quasi-experientialstudy was conducted at the Paediatric Medical Department of Kafrelsheikh University Hospital, Egypt, from November 2021 to April 2022, and comprised children of either gender aged 6-12 years. The subjects were randomised into flippits group A, virtual reality group B and control group C in which only traditional care was provided. Data was collected using a structured interview, Wong-Baker Faces Pain Rating Scale, Children's Fear Scale, and Blood Specimen Collection Satisfaction Evaluation Scale. Data was analysed using SPSS 20. RESULTS: Of the 120 children, 40(33.3%) were in each of the three groups. There were 21(52.5%) boys and 19(47.5%) girlsin group A with mean age 8.2±1.6 years, 22(55%) boys and 18(45%) girlsin group B with mean age 7.8±1.7 years, and 27(67.5%) boys and 13(32.5%) girls in group C with mean age 7.9±1.9 years (p>0.05). Mean pain and fear scores were significantly lower and mean satisfaction score was higher in groups A and B than group C (p<0.05). There was no significant difference in the mean pain scores of group A and group B (p>0.05). CONCLUSIONS: Flippits and virtual reality interventions had a positive effect on pain, fear and satisfaction levelsin children during phlebotomy.

Case Report Of Rib Polyostotic Fibrous Dysplasia.

Polyostotic fibrous dysplasia is a rare benign asymptomatic tumour of the ribs not requiring surgery on most occasions. We present here a case with left 10th and 11th rib fibrous dysplasia which was causing a hinderance to the Urologist for renalstone extraction. Therefore the 10th and 11th ribs were excised followed by chest wall reconstruction.

Use of Basilic vein in arteriovenous fistulas construction for hemodialysis access. Is it a good option alternative to prosthetic arteriovenous grafts?

PURPOSE: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. PATIENTS AND METHODS: A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. RESULTS: Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was significantly higher in AF than in BG at 12-month followup: 77.7% vs 53.1% (p < 0.012). secondary patency rate was higher in AF than in BG at 1-year follow-up 62.5% vs 42.8% (p = 0.063), respectively. In addition, BGs required more interventions to preserve patency. CONCLUSIONS: AF had higher primary, secondary and overall functional patency rates and needed fewer procedures to keep patency than BGs. Cases that need early vascular access as a result of central venous catheter complications or who have a reduced life expectancy may benefit from BGs.

Long-term effect of sleeve gastrectomy surgery on Hormonal Profile, Semen Parameters and sexual functions of obese infertile men; a prospective observational study.

BACKGROUND: The effect of bariatric surgery on impaired semen parameters, hormonal profile and sexual function remains controversial to some extent. THE CONTEXT AND PURPOSE OF THE STUDY: To look at the long-term effects of sleeve gastrectomy on hormonal profiles, sperm parameters, and sexual function in infertile men with severe obesity. This prospective study included fifty-four obese patients with primary or secondary infertility who were scheduled for sleeve gastrectomy between February 2018 and March 2021. All participants were given a sperm analysis and a serum hormone profile before, 12, and 18 months after surgery. We used the International Index of Erectile Function questionnaire to assess sexual function. RESULTS: There was a significant correlation between weight loss after sleeve gastrectomy and improvement in lipid profile (p < 0.05). No significant detectable effect of post-gastrectomy weight loss on patients with diabetes mellitus, hypertension, or obstructive sleep apnea. As regards the hormonal profile, sex hormone binding globulin, total and free testosterone improved significantly after 12- and 18-months following sleeve gastrectomy. There was a significant increase in sperm count and total sperm number during the follow-up after sleeve gastrectomy (p < 0.05), however, there were no significant changes in other semen parameters. Concerning sexual function, sexual desire, erectile function, and satisfaction improved significantly at 12 and 18 months after surgery. CONCLUSION: Weight loss through sleeve gastrectomy surgery significantly improves testosterone deficiency, sexual performance, and Sperm count in obese infertile men.

RéSUMé: CONTEXTE: L'effet de la chirurgie bariatrique sur l'altération des paramètres du sperme, du profil hormonal et de la fonction sexuelle, reste controversé dans une certaine mesure. Le contexte et le but de l'étude : examiner les effets à long terme de la gastrectomie longitudinale sur les profils hormonaux, les paramètres du sperme et la fonction sexuelle chez les hommes infertiles souffrant d'obésité sévère. Cette étude prospective comprenait 54 patients obèses, atteints d'infertilité primaire ou secondaire, qui devaient subir une gastrectomie longitudinale entre février 2018 et mars 2021. Tous les participants ont eu une analyse de sperme et un profil hormonal sérique avant, puis 12 et 18 mois après la chirurgie. La fonction sexuelle a été évaluée au moyen du questionnaire de l'indice international de la fonction érectile. RéSULTATS: Une corrélation significative était présente entre la perte de poids après la gastrectomie longitudinale et l'amélioration du profil lipidique (p < 0,05). Aucun effet significatif détectable de la perte de poids post-gastrectomie n'a été retrouvé chez les patients atteints de diabète, d'hypertension ou d'apnée obstructive du sommeil. En ce qui concerne le profil hormonal, la globuline liant les hormones sexuelles, la testostérone totale et la testostérone libre se sont significativement améliorées à 12 et 18 mois après la gastrectomie longitudinale. Il y eut une augmentation significative de la numération de spermatozoïdes et du nombre total de spermatozoïdes au cours du suivi après la gastrectomie longitudinale (p < 0,05) ; sans, toutefois, de changements significatifs pour les autres paramètres du sperme. En ce qui a concerné la fonction sexuelle, le désir sexuel, la fonction érectile et la satisfaction se sont considérablement améliorés 12 et 18 mois après la chirurgie. CONCLUSION: La perte de poids due à la chirurgie par gastrectomie longitudinale améliore significativement le taux de testostérone, la performance sexuelle et le nombre de spermatozoïdes chez les hommes infertiles obèses.

In Situ Construction of Nitrogen-Doped and Zinc-Confined Microporous Carbon Enabling Efficient Na+-Storage Abilities.

Benefiting from the additional active sites for sodium-ion (Na+) adsorption and porous architecture for electrolyte accessibility, nitrogen-doped porous carbon has been considered the alternative anode material for Na+-storage applications. In this study, nitrogen-doped and zinc-confined microporous carbon (N,Z-MPC) powders are successfully prepared by thermally pyrolyzing the polyhedral ZIF-8 nanoparticles under an argon atmosphere. Following the electrochemical measurements, the N,Z-MPC not only delivers good reversible capacity (423 mAh/g at 0.02 A/g) and comparable rate capability (104 mAh/g at 1.0 A/g) but also achieves a remarkable cyclability (capacity retention: 96.6% after 3000 cycles at 1.0 A/g). Those can be attributed to its intrinsic characteristics: (a) 67% of the disordered structure, (b) 0.38 nm of interplanar distance, (c) a great proportion of sp2-type carbon, (d) abundant microporosity, (e) 16.1% of nitrogen doping, and (f) existence of sodiophilic Zn species, synergistically enhancing the electrochemical performances. Accordingly, the findings observed here support the N,Z-MPC to be a potential anode material enabling exceptional Na+-storage abilities.

Safety and Efficacy of Mitoxantrone Hydrochloride Injection for Identification of Axillary Sentinel Lymph Nodes in Patients with Primary Breast Cancer.

BACKGROUND: The dual technique using blue dye in combination with a radioisotope is considered the gold standard for identifying sentinel lymph nodes (SLNs) in patients with breast cancer. Unfortunately, not all cancer centres have access to radioactive material, which jeopardizes the SLN identification rate and patient safety. AIM: We aimed to assess the safety and efficacy of mitoxantrone hydrochloride injection (MHI) for identifying axillary SLNs in patients with primary breast cancer. PATIENTS AND METHODS: We have conducted a prospective non-randomized analysis of patients diagnosed with invasive breast cancer who agreed to participate in the study between December 2019 and December 2022. We have used the patient's medical records to collect the data. We have used the SLN intraoperative identification rate as a marker for the efficacy of the technique and both the immediate and delayed complication rates and routine blood tests as markers for the safety of the technique. RESULTS: Out of the 296 patients, 289 (97.6%) had their SLNs identified using MHI, while seven patients (2.3%) had four-node sampling carried out because the SLNs were not identified. Liver functions were not significantly affected by MHI, and there was no technique-related readmission or reported morbidity or mortality. CONCLUSION: We have found that the MHI technique is still inferior to the combined radioactive directed technique and patent blue V dye in SLN identification. Yet, it may serve as a safe and reliable alternative in cases where the radioactive technique is unavailable.

Subcutaneous vs Intravenous Administration of Medications and Fluids for Patients With Cancer in the US and Canada.

This cross-sectional study compares rates of subcutaneous and intravenous administration of medications and fluids among patients with cancer in 2 acute palliative care units in the US and Canada.

Obesity Indices and Ventilatory Function Responses to High-Level Laser Therapy in Subjects with Abdominal Obesity.

Objective: The aim of this study is to investigate the effectiveness of pulsed Nd:YAG high-intensity laser therapy (HILT) on body weight (Wt), body-mass index (BMI), waist circumference (WC), forced vital capacity (FVC), and forced expiratory volume in 1 sec (FEV1) in young adults with abdominal obesity (AO). Materials and methods: Thirty-seven young adult males (age 19-25 years) with BMI >30 kg/m2 and WC >102 cm participated in this 12-week, randomized controlled study and were randomly allocated into either Group I [received pulsed Nd:YAG HILT plus moderate-intensity aerobic exercise training (AET) program] or Group II (received placebo pulsed Nd:YAG HILT plus the same AET program). The variables were evaluated pre- and poststudy. Results: Poststudy mean values and percentages of changes were calculated for Wt [83.7 ± 6.58 kg (-6.14%) and 88.71 ± 5.09 kg (-4.29%)], BMI [29.27 ± 1.06 kg/m2 (-6.14%) and 30.09 ± 1.23 kg/m2 (-4.24%)], WC [105.44 ± 5.84 cm (-3.78%) and 109.42 ± 4.9 cm (-1.74%)], FVC [4.79 ± 0.4 L (+13.6%) and 4.39 ± 0.66 L (+5.89%)], and FEV1 [4.04 ± 0.22 L (+16.4%) and 3.82 ± 0.39 L (+8.8%)] for Group I and Group II, respectively. Between groups, there were significant differences in mean values of Wt (p = 0.014), BMI (p = 0.04), WC (p = 0.03), FVC (p = 0.03), and FEV1 (p = 0.04) at the end of the study, but in favor of Group I. Conclusions: Utilizing the pulsed Nd:YAG HILT as an adjunctive therapeutic modality proved to be effective in improving the anthropometric indices and ventilatory functions in subjects with AO.

Palliative care for adolescents and young adults with advanced illness: A scoping review.

BACKGROUND: Age-related complex medical conditions have been commonly reported among adolescents and young adults with advanced life-limiting illness. There is increasing interest in exploring their palliative care needs and end-of-life experiences. AIM: This scoping review aimed to explore the available literature about providing palliative and end-of-life care to adolescents and young adults with advanced life-limiting illnesses. DESIGN: Scoping review. This review was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/SPTD7). DATA SOURCES: Electronic databases (MEDLINEALL, Embase, Emcare, Cochrane Central Register of Controlled Trial CENTRAL, Scopus, PsycINFO, Cochrane Database of Systematic Reviews), Google Scholar and reference lists were searched up to October 2021. We included studies reporting on adolescents and/or young adults with advanced life-limiting illnesses. There were no limitations concerning location, type of illness or study design. RESULTS: We identified 51 studies published between 2002 and 2021. Most studies were published in the United States (n = 34, 67%), and nine studies (18%) reported exclusively on patients with non-malignant illnesses. Two thirds of the identified studies were case reports and retrospective chart reviews (n = 33). Three main topics were identified: Physical symptom burden (n = 26, 51%), Psychological and social needs (n = 33, 65%), and end-of-life care (n = 30, 59%). Twenty-six studies (51%) were focused only on one topic, and the age range used to identify adolescents and young adults varied based on the study location. CONCLUSION: The findings of this review shed light on the different palliative care experiences and knowledge gaps related to adolescents and young adults as an underserved and vulnerable patient population. Further research needs to be dedicated toward palliative care programs tailored for adolescents and young adults.

Urinary epidermal growth factor and monocyte chemotactic protein-1 as biomarkers of renal injury in patients with obstructed nephropathy.

OBJECTIVE: To evaluate the role of urinary Monocyte Chemotactic Protein-1 (MCP1) and urinary epidermal growth factor (EGF) in diagnosing of upper urinary tract obstruction (UUTO). PATIENT AND METHODS: Over a period of 6 months (January 2022 to June 2022) this prospective case control comparative study was conducted on 120 participants, 60 of them with UUTO and 60 healthy controls. A morning urine sample of all participants was tested for EGF and MCP-1. after taking a detailed history taking and laboratory and radiological evaluation. RESULTS: Urinary MCP-1(uMCP-1) was significantly (p-value = 0.000) increased in UUTO group showing a mean ± SD of 518.10 ± 51.19 ng/L compared to a mean ± SD of 143.32 ± 58.03 ng/L in the controls, whereas a significantly (p-value = 0.000) decrease of urinary EGF (uEGF) was observed in patients with UUTO compared to control group. A significant difference of uEGF level and uEGF/uMCP1 ratio was observed between mild compared to moderate/severe UUTO. CONCLUSIONS: Utilization of the urinary biomarker MCP1, EGF and uEGF/uMCP1 ratio in patients with UUTO can adequately be used as a simple, efficacious and noninvasive way in diagnosis of UUTO.

Endoscopic combined intrarenal surgery in the prone split-leg position versus Galdakao-modified supine Valdivia position for the management of partial staghorn calculi.

OBJECTIVE: To evaluate and compare the outcome of ECIRS in the treatment of partial staghorn renal calculi in both prone split-leg positions versus GMSV positions with regard to; technical aspects, success rate, operative time, complications, safety, and effectiveness of both approaches. PATIENTS AND METHODS: Between October 2018 and August 2021, 66 patients with partial staghorn calculi were enrolled in this prospective comparative study. Patients were randomly divided according to a 1:1 ratio into two groups. Group A included 33 patients who were treated by (ECIRS) in the prone split-leg position, and group B included 33 patients who were treated by (ECIRS) in the Galdakao-modified supine Valdivia (GMSV) position. RESULTS: No significant statistical difference between both groups regarding the mean age (p = 0.448), mean body mass index (BMI) (p = 0.137), mean stone burden (p = 0.435), mean operative time (p = 0.541) and the number of calyces located in branched stones (p = 0.628). The mean hospital stay was 6.71 ± 1.12 days for group A and 6.66 ± 1.10 days for group B patients (p = 0.724). The final SFR was achieved in (29)87.87% and (30)90.9% of group A & B patients, respectively (p = 0.694). No significant difference was detected between both groups in perioperative complication rates. CONCLUSION: ECIRS is safe and effective in treating partial staghorn calculi either in the prone split-leg position or in the Galdakao-modified supine Valdivia position, with comparable outcomes and no statistically significant difference between both positions.

Urodynamic changes following laparoscopic versus vaginal hysterectomy.

OBJECTIVE: To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases. PATIENTS AND METHODS: A total of 90 women with a mean age of 56.36-years were enrolled in this study between August 2019 and April 2021. They were divided into two equal groups (45 patients each). Group, I had a vaginal hysterectomy, and Group II had a laparoscopic hysterectomy. All patients were assessed clinically using ICIQ-FLUTS questionnaire and a uro-dynamic study before and six months after surgery. RESULTS: Both vaginal and laparoscopic hysterectomy did not significantly change the maximum flow rate, voiding time, and average flow rate. The increase in residual urine volume in group I was not significant (p = 0.129), as was in Group II (p = 0.217). All the modifications, however, were within permis-sible limits. According to the cystometry result, volume at initial sensation rose in both groups after surgery, with no statistically significant difference (p = 0.364). After both forms of hysterecto-my, maximum bladder capacity did not vary considerably. Preoperatively, all study participants exhibited no overactivity of the detrusor muscle; nevertheless, following surgery, overac-tivity was noted in 9 patients after vaginal hysterectomy com-pared to three patients after laparoscopic hysterectomy, and all the alterations were within a clinically acceptable range. In addition, the ICIQ-FLUTS score was not significantly different between the study groups. CONCLUSIONS: According to the urodynamic study, hysterectomy for benign uterine conditions, whether vaginal or laparoscopic did not adversely affect urinary bladder function.

Augmented Therapeutic Potential of EC-Synthetic Retinoids in Caco-2 Cancer Cells Using an In Vitro Approach.

Colorectal cancer therapies have produced promising clinical responses, but tumor cells rapidly develop resistance to these drugs. It has been previously shown that EC19 and EC23, two EC-synthetic retinoids, have single-agent preclinical anticancer activity in colorectal carcinoma. Here, isobologram analysis revealed that they have synergistic cytotoxicity with retinoic acid receptor (RAR) isoform-selective agonistic retinoids such as AC261066 (RARß2-selective agonist) and CD437 (RARγ-selective agonist) in Caco-2 cells. This synergism was confirmed by calculating the combination index (lower than 1) and the dose reduction index (higher than 1). Flow cytometry of combinatorial IC50 (the concentration causing 50% cell death) confirmed the cell cycle arrest at the SubG0-G1 phase with potentiated apoptotic and necrotic effects. The reported synergistic anticancer activity can be attributed to their ability to reduce the expression of ATP-binding cassette (ABC) transporters including P-glycoprotein (P-gp1), breast cancer resistance protein (BCRP) and multi-drug resistance-associated protein-1 (MRP1) and Heat Shock Protein 70 (Hsp70). This adds up to the apoptosis-promoting activity of EC19 and EC23, as shown by the increased Caspase-3/7 activities and DNA fragmentation leading to DNA double-strand breaks. This study sheds the light on the possible use of EC-synthetic retinoids in the rescue of multi-drug resistance in colorectal cancer using Caco-2 as a model and suggests new promising combinations between different synthetic retinoids. The current in vitro results pave the way for future studies on these compounds as possible cures for colorectal carcinoma.