Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. Conclusion: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence: Oxford Level 3.

Genetic variants associated with osteosarcoma risk: a systematic review and meta-analysis.

Osteosarcoma (OS) is the most common type of primary bone malignancy. Common genetic variants including single nucleotide polymorphisms (SNPs) have been associated with osteosarcoma risk, however, the results of published studies are inconsistent. The aim of this study was to systematically review genetic association studies to identify SNPs associated with osteosarcoma risk and the effect of race on these associations. We searched the Medline, Embase, Scopus from inception to the end of 2019. Seventy-five articles were eligible for inclusion. These studies investigated the association of 190 SNPs across 79 genes with osteosarcoma, 18 SNPs were associated with the risk of osteosarcoma in the main analysis or in subgroup analysis. Subgroup analysis displayed conflicting effects between Asians and Caucasians. Our review comprehensively summarized the results of published studies investigating the association of genetic variants with osteosarcoma susceptibility, however, their potential value should be confirmed in larger cohorts in different ethnicities.

Pattern and determinants of COVID-19 infection and mortality across countries: An ecological study.

BACKGROUND: This work aimed to identify the mathematical model and ecological determinants of COVID-19 infection and mortality across different countries during the first six months of the pandemic. METHODOLOGY: In this study, authors used the online available data sources of randomly selected 18 countries to figure out potential determinants of COVID-19 transmissibility and mortality. The studied variables were environmental factors (daily average temperature, daily humidity), socioeconomic attributes (population age structure, count and density, human development index, per capita income (PCI), gross domestic product, internet coverage) mobility trends and chronic diseases. Researchers used the linear and exponential time series analysis, and further utilized multivariate techniques to explain the variance in the monthly increase in cases and deaths. RESULTS: In the first two months, the R2 of linear models for the cases and deaths were higher than that of the corresponding R2 of the exponential model. Later one, R2 of the exponential model was occasionally relatively higher than that of the linear model. The exponential growth rate of new cases was significantly associated with mobility trends (ß = 0.00398, P = 0.002), temperature (ß = 0.000679, P = 0.011), humidity (ß = 0.000249, P < 0.001), and the proportion of population aged ≥65 years (ß = -0.000959, P = 0.012). Similarly, the exponential growth rate of deaths was significantly associated with mobility trends (ß = 0.0027, P = 0.049), temperature (ß = 0.0014, P < 0.001), humidity (ß = -0.0026, P < 0.001), and PCI of countries. During this period, COVID-19 transmissibility was evident to be controlled as soon as social mobility is decreased by about 40% of the baseline over 3 months controlling for the other predictors. CONCLUSION: Controlling of COVID-19 pandemic is based mainly on controlling social mobility. Role of environmental determinants like temperature and humidity was well noticed on disease fatality and transmissibility. Socio-demographic determinants of COVID-19 spread and fatality included modifiable risk factors like PCI and non-modifiable risk factors like ageing.

Improving hybrid Pennisetum growth and cadmium phytoremediation potential by using Bacillus megaterium BM18-2 spores as biofertilizer.

Environmental pollution with heavy metals becomes an issue of serious concern worldwide. Cadmium is considered one which adversely affects living organisms. Recently, the usage of endophytic bacteria to enhance the plant growth and phytoremediation of heavy metals contaminated sites is gaining great attention. The current study focused on utilizing the spores of Bacillus megaterium BM18-2 as biofertilizer for enhancing the growth of Cd hyperaccumulator Hybrid Pennisetum and Cd tolerance of the plant. Therefore, the production of the highest proportion of BM18-2 spores in short incubation time was investigated using different culture media. The results revealed that the maximum proportion of BM18-2 spores (90%) was obtained following incubation for 48 h in Tryptone- yeast extract media (TY). Furthermore, several growth parameters of H. Pennisetum were shown to be significantly improved by inclusion of BM18-2 spores into Cd contaminated soil in contrast to non- inoculated plant. The chlorophyll concentration of the leaves rose by 5%, 13%, and 22.89% with increasing Cd concentration of soil (20, 40 and 60 mg/Kg, respectively). The percentage of total nitrogen content of the root, stem and leaf was increased due to the bacterial spores inoculation and the highest percentage was recorded in the leaf in all treatments. Moreover, Cd phytoremediation capacity of H. Pennisetum greatly enhanced with the application of BM18-2 spores into the soil. An obvious correlation was also observed between Cd accumulation and bacterial colonization where the Cd accumulation enhanced by 21.9%, 16.5%, and 94.6% and the maximum count of BM18-2 (27 × 105, 194 × 104,and 145 × 104 CFU/g) were recorded in the root system in 20, 40, and 60 mg/Kg Cd spiked soil, respectively. Consequently, the spores of BM18-2 was proven to succeed as biofertilizer to improve growth of H. pennisetum during Cd stress which subsequently improved the phytoremediation of Cd contaminated soil.

Catfish Glycoprotein, a Highly Powerful Safe Preservative of Minced Beef Stored at 4 °C for 15 Days.

Minced beef is a very perishable food product, due to its vulnerability to microbial contamination and its fast quality deterioration. In the current study, the biological efficiency of different concentrations (0, 50 and 100 µg g-1) of the antibacterial catfish glycoprotein (CFG) was estimated as a possible improver of the storability and safety of minced beef preserved at 4 °C for 15 days. CFG (50 and 100 µg g-1) could efficiently control the changes in meat pH during 15 days storage at 4 °C to be within the normal, acceptable levels (6.4 and 6.2, respectively), equalizing the level of the control for minced beef after 6 days of storage under similar conditions. Likewise, the level of metmyoglobin in minced beef stored at the same conditions was maintained at 53.67 and 46.67% by CFG supplementation at 50 and 100 µg g-1, respectively, at the 15th day of storage, which is comparable to the 6th day in case of the control samples. However, the antioxidant effect of CFG against lipid peroxidation was less effective. The antibacterial action of CFG was most pronouncedly powerful and efficient. Supplementation of minced beef with CFG at 50 and 100 µg g-1 significantly (p < 0.05) decreased the bacterial counts at all the time inspection points as compared to the control. After 15 days of storage, the total viable bacteria, psychrotrophic bacterial count and coliforms count were reduced to 3.12, 2.65 and 0.0 log CFU g-1, respectively, in response to CFG (50 µg g-1), and 2.41, 2.04 and 0.0 log CFU g-1, respectively, in response to CFG (100 µg g-1); this compared to 5.13, 4.78 and 2.5 in the control samples after only six days cold storage. Using CFG at 50, 100 and 200 µg g-1 in rat diets did not affect their liver or kidney functions, reflecting the non-toxicity of this substance. Substantiating the antioxidant and antimicrobial potential of CFG in minced beef storage may support its use as a naturally powerful and safe food preservative, as well as a shelf-life extender.

Endophytic Bacillus megaterium BM18-2 mutated for cadmium accumulation and improving plant growth in Hybrid Pennisetum.

Hybrid Pennisetum (Pennisetum americanum × P. purpureum Schumach L.) is a tall and rapidly growing perennial C4 bunch grass. It has been considered as a promising plant for phytoremediation of heavy metal-contaminated soil due to its high biomass, high resistance to environmental stress, pests and diseases. Heavy metal bioavailability level is the most important parameter for measurement of the phytoremediation efficiency. Endophytic bacteria were used to further enhance phytoremediation of heavy metals through bioaccumulation or bioabsorption process. In the present study, the endophytic Bacillus megaterium strain 'BM18' isolated from hybrid Pennisetum was screened under 10-70 µM cadmium (Cd) stress for Cd-resistant mutant colonies. And one such mutant colony'BM18-2' was obtained from the screen. Comparably, 'BM18-2' was more Cd-tolerant and had higher Cd removal ability than the original strain'BM18'. The amount of IAA and ammonia production, and phosphate solubilization were 1.09, 1.23 and 1.24 times in 'BM18-2' than those of 'BM18', respectively. Full genome sequencing of these two strains revealed 6 different genes: BM18GM000901, BM18GM005669 and BM18GM005870 encoding heavy metal efflux pumps, BM18GM003487 and BM18GM005818 encoding transcriptional regulators for metal stress biosensor and BM18GM001335 encoding a replication protein. Inoculation with 'BM18-2' or 'BM18' both significantly reduced the toxic effect of Cd on hybrid Pennisetum, while the effect of 'BM18-2' on plant growth promotion in the presence of Cd was significantly better that of 'BM18'. Therefore, the mutated strain 'BM18-2' could be used as a potential agent for Cd bioremediation, improving growth and Cd absorption of hybrid Pennisetum in Cd contaminated soil.

Peeling Skin Syndrome: A Pathologically Invisible Dermatosis.

Peeling skin syndrome is a relatively rare clinical case with pathology of apparently normal skin that needs clinical details to reach accurate diagnoses. Hence, this case was used as examples to declare how it is important for both the pathologist and the dermatologist to cooperate to reach an accurate diagnosis.

Biochemical, biological characteristics and antibacterial activity of glycoprotein extracted from the epidermal mucus of African catfish (Clarias gariepinus).

Catfish glycoprotein (CFG) was extracted from the cutaneous mucus of Egyptian catfish by ammonium sulphate precipitation and purified on gel filtration column (sephadex G-50). After purification, CFG produced one band on SDS-PAGE (22 kDa). Urea-PAGE and the pH-solubility of CFG indicated its positive charge (IEP 8). CFG contained 12 saccharides. FTIR spectrum shows 3 groups of bands at 1800-2900, 1100-1700 and 700-1100 cm-1. CFG exhibited antibacterial activity against 9 pathogenic bacteria with low MIC (50 µg/mL), where two Gram+ bacteria, i.e.; Streptococcus pyogenes (St. pyogenes) and Listeria ivanovii (L. ivanovii) were the most sensitive. The growth curves of the bacteria subjected to 1 MIC of CFG during 30 h showed general growth inhibition, particularly in case of Gram- bacteria such as E. coli. TEM images showed evidently reduced relative content of the intact cells and clear incurred cellular malformations. Combining CFG with specific antibiotic at equal ratios induced synergistic antibacterial actions, amounting to 40% of the mathematical sum of the combination. Substituting the antibiotic chloramphenicol with gradual increasing ratios of CFG of its starting concentration (30 µg/mL), produced proportionally bigger antibacterial actions against St. pyogenes growth and increasing synergistic effect up to 37% at 80% of CFG substitution.

Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome.

BACKGROUND: Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. METHODS: Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome. RESULTS: The mean follow-up period was 48.7 months (12-104 months). The mean age at presentation was 10.3 years (5-17 years). The average length of the resected femoral shaft was 19.2 cm (15-24 cm) and the average length of the harvested fibula was 17.4 cm (15-21 cm). The mean time to union was 4.8 months (1-6 months) and the mean hypertrophy index was 78% (15.5-184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56-100%) and the mean limb length inequality was 4.75 cm (3-11 cm). CONCLUSION: Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting. LEVEL OF EVIDENCE: IV.

Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients.

BACKGROUND: Complete metastasectomy is the best predictor of survival in patients with osteosarcoma pulmonary metastases. There has been some controversy in the literature regarding the prognostic significance of the timing of occurrence of lung metastasis. METHODS: We reviewed the clinical course of all osteosarcoma patients with pulmonary metastases treated by metastasectomy in our hospital from January 2008 through December 2016. Each patient who underwent metastasectomy was placed into one of three groups based on whether lung metastases were present at initial presentation (Group 1), developed during chemotherapy (Group 2), or appeared after completion of chemotherapy (Group 3). Data were obtained retrospectively and follow-up was obtained until the end of June 2017. RESULTS: We identified 170 patients with pulmonary nodules of whom 99 (58.2%) underwent at least one metastasectomy (149 thoracotomies). Eleven patients had benign pulmonary nodules and were excluded. The other 88 patients were classified as Group 1 (37), Group 2 (18) or Group 3 (33). The median follow-up was 35 months (range 8 to 99). Postmetastasis 5-year overall survival (OS) was 38.1 ±â€¯6.4%; event-free survival (EFS) was 25 ±â€¯5.3%. By group, postmetastasis 5-year OS and EFS were 34.3 ±â€¯13% and 18 ±â€¯9.3% in Group 1, 8 ±â€¯6.5% and 6.5 ±â€¯5% in Group 2, and 52 ±â€¯11.4% and 25 ±â€¯9% in Group 3 (P < 0.001). In univariate analysis, the only significant factors associated with survival were timing of occurrence of lung metastasis and the number of lung nodules found. CONCLUSION: The timing of occurrence of lung metastasis is an important prognostic factor among osteosarcoma patients eligible for metastasectomy. Patients whose metastases occurred during chemotherapy had the worst survival. LEVEL OF EVIDENCE: Level II.

Reconstruction of the Scapula in Pediatric and Adolescent Patients After Total Scapulectomy. A Report of 10 Patients Treated by Extracorporeal Irradiation and Reimplantation of the Scapula.

BACKGROUND: Ewing sarcoma of the scapula is uncommon. Restoration of shoulder function after total scapulectomy is challenging. Extracorporeal irradiation and reimplantation is a well-known method of biological reconstruction in orthopaedic oncology; yet very few reports in the literature describe its specific use in tumors of the scapula. PATIENTS AND METHODS: Ten patients with the diagnosis of Ewing sarcoma of the scapula were surgically treated by total scapulectomy and extracorporeal irradiation and reimplantation of the scapula. The mean age at presentation was 10 years (3 to 15 y). Six patients were male individuals and 4 were female individuals. An extracorporeal single dose of 5000 cGy was applied to each graft. At reimplantation, internal fixation was used in the first 2 cases, whereas, in the following 8 patients, stabilization was carried out by resuturing of the glenohumeral and acromioclavicular joint capsules without internal fixation. An ipsilateral Latissimus Dorsi muscle flap was used in all patients to cover the irradiated scapula. RESULTS: The mean follow-up duration was 29.2 months (13 to 50 m). At the latest follow-up, 8 patients were continuously disease free and 2 patients had systemic relapse. No patient had local recurrence. The mean musculoskeletal tumor society functional score was 87% (66.6% to 100%). Eight of the 10 patients (80%) could actively elevate the upper limb up to and beyond 90 degrees in both the forward and scapular planes. Complications included wound gaping in 2 patients (20%), dislocation of the acromioclavicular joint in 3 patients (30%), and partial resorption of the scapular graft in 5 patients (50%). No patient showed any progressive deterioration of his or her shoulder function throughout the follow-up period. CONCLUSIONS: The irradiated scapular graft provides a stable biological fulcrum for the reattached muscles of the shoulder joint after total scapulectomy, thereby providing an adequate postoperative range of shoulder elevation. A longer follow-up study is needed to evaluate the progression and effect of graft resorption on the functional outcome. LEVEL OF EVIDENCE: Level IV.

Outcome of resectable pediatric Ewing sarcoma of the ribs.

PURPOSE: Was to evaluate the outcome of multimodality treatment in resectable primary Ewing sarcoma/primitive neuroectodermal tumor ES/PNET of the ribs and role of thoracoscopy in facilitating resection of these tumors. PATIENTS AND METHODS: This was a retrospective study including 22 patients with primary ES/PNET of the ribs surgically treated at Children's Cancer Hospital Egypt (CCHE) between January 2008 until the end of December 2014. RESULTS: Median age was 8.5years (range 5months to 16years.). All patients received neoadjuvant chemotherapy. Thoracoscopic exploration was performed in 15 (68%) patients. Resection included 1,2,3 and 4 ribs in (7,4,8 and 3 patients) respectively, parts of the diaphragm (3 patients), wedge resection of the lung (10 patients) and pleural nodules (2 patients). Primary closure was feasible in 11 patients and rib transposition was done in one patient. Reconstruction by proline mesh covered by muscle flap was done in 10 patients. Margins were microscopically positive in 3 patients and close in 2 patients. Postoperative radiotherapy was given in 8 patients. With a median follow-up of 38.5months, the 3-year event -free survival (EFS) and overall survival(OS) rates were 31.6% and 55.6%, respectively. CONCLUSION: Multimodality treatment is essential in the management of ES-PNET of the ribs. Neoadjuvant chemotherapy facilitates adequate resection. The role of thoracoscopy and the indications of postoperative radiotherapy need further evaluation.