Efficacy and safety of etrolizumab in treatment of moderate to severe ulcerative colitis: A systematic review and meta-analysis.

Background: Etrolizumab is a promising drug for treating moderate to severe ulcerative colitis. Aim: The aim of this study was to assess the efficacy and safety of etrolizumab for induction and maintenance of remission in moderate to severe ulcerative colitis. Methods: We searched the following databases: PUBMED, Web of Science, OVID, and SCOPUS from inception to January 15. Inclusion criteria were any phase 2 and 3 clinical trials that compared etrolizumab with a placebo in treating moderate to severe ulcerative colitis, excluding case reports, animal studies, phase 1 trials, and conference abstracts due to duplication. We used RevMan software (5.4) for the meta-analysis. Results: Five clinical trials were included in our meta-analysis. The total number of patients included in the study is 1248 patients, 860 patients in the etrolizumab group and 388 patients in the placebo group. In the induction phase, the pooled analyses showed a statistically significant association between etrolizumab and increased clinical remission, and endoscopic remission compared with placebo (risk ratio [RR] = 2.66, 95% confidence interval [CI] = 1.69-4.19, p < 0.0001), and (RR = 2.35, 95% CI = 1.52-3.65, p = 0.0001), respectively. In the maintenance phase, the pooled analyses showed a statistically significant association between etrolizumab and increased histologic remission and endoscopic remission (RR = 2.04, 95% CI = 1.40-2.98, p = 0.0002) and (RR = 1.92, 95% CI = 1.29-2.85, p = 0.001), respectively. No statistically significant difference was observed in adverse events between etrolizumab and placebo in the induction and maintenance phases. Conclusion: Our results show that etrolizumab is an effective and safe drug for the induction and maintenance of clinical remission in moderate to severe ulcerative colitis patients, as proved by histologic and endoscopic findings. Future randomized trials are still needed to compare etrolizumab to the other agents and further establish its value for the practice.

Separation, reserve estimation and radioactivity responsibility of the economic heavy minerals of East El- Arish black sand, North Sinai, Egypt.

Multi-heavy mineral separation techniques like density, magnetic, and electromagnetic techniques are followed by picking, grain counting, and mineralogical examinations conducted with an environmental scanning electron microscope (ESEM). These techniques have been applied to several drill hole (well) composite samples representing beach sand and dunes of East El-Arish area, North Sinai, Egypt. The results explain the remarkable enrichment in total heavy minerals (THM) of beach sand (4.4%) compared to sand dunes (2.6%): this is due to the natural concentration of the currents of the Mediterranean Sea. After characterizing the heavy minerals in terms of the abundance of each mineral species, the mean values of content relative to total economic heavy minerals (TEHM) were determined as 70.03% ilmenite, 3.81% leucoxene, 3.03% magnetite, 8.7% garnet, 10.6% zircon, 3.13% rutile, 0.37% monazite, and 0.31% titanite in the sand dune samples. The total economic heavy minerals in the beach samples were 64.08% ilmenite, 1.6% leucoxene, 2.84% magnetite, 18.16% garnet, 10.4% zircon, 2.18% rutile, 0.61% monazite, and 0.13% titanite. Monazite, thorite, zircon, and apatite are the main radioactive minerals in the study area. The combination of two specific characteristics of the studied monazite (relatively high Th-U content and high frequency) makes monazite the main contributor to radioactivity of the study area.

Association of familial Mediterranean fever and epicardial adipose tissue: A systematic review and meta-analysis.

Background and Aim: Some studies reported a positive link between familial Mediterranean fever (FMF) and epicardial adipose tissue. Our meta-analysis aimed to evaluate whether there is a significant association between FMF and increased epicardial adipose tissue thickness. Methods: We searched the following databases: PUBMED, WOS, OVID, SCOPUS, and EMBASE. Inclusion criteria were any original articles that reported epicardial adipose tissue in FMF patients with no age restriction, excluding reviews, case reports, editorials, animal studies, and non-English studies. Thirty eligible studies were screened full text but only five studies were suitable. We used RevMan software (5.4) for the meta-analysis. Results: The total number of patients included in the meta-analysis in the FMF patients group is 256 (mean age = 24.3), and the total number in the control group is 188 (mean age = 24.98). The pooled analysis between FMF patients and controls was [mean difference = 0.82 (95% CI = 0.25-1.39), p-value = 0.005]. We observed heterogeneity that was not solved by random effects (p > 0.00001). We performed leave one out test by removing the Kozan et al. study, and the heterogeneity was solved (p = 0.07), and the results were (MD = 0.98, 95% CI = 0.52-1.43, p-value < 0.0001). Conclusion: FMF patients are at increased risk of developing epicardial adipose tissue compared to controls. More multicenter studies with higher sample sizes are needed to support our results.

Radioactive risk assessment of beach sand along the coastline of Mediterranean Sea at El-Arish area, North Sinai, Egypt.

Beach sand includes various levels of natural radioactivity, which can cause health effects. The natural radioactivity was measured in the beach sand along the coastline of the Mediterranean Sea at the east of the El-Arish area, Egypt. Using the HPGe spectrometer, the contribution of radionuclides 226Ra, 232Th and 40K in the gamma emitted radiation illustrated that the 226Ra, 232Th and 40K activity concentrations are 8.8 ± 3.9, 30.8 ± 12.2 and 106.9 ± 46.8 Bq kg-1, respectively, which is lower than the reported worldwide limit 33, 45 and 412 Bq kg-1. The radioactive hazards associated with the beach sand along the coastline of the Mediterranean Sea at the east of the El-Arish area were investigated. The obtained results among the radiological hazard parameters, the radium equivalent content (Raeq), the absorbed dose rate (Dair), annual effective dose (AED), external (Hex) and internal (Hin) hazard indices were estimated. Moreover, the excess lifetime cancer risk (ELCR) and the annual gonadal dose equivalent (AGDE) were also computed and illustrated their values less than the recommended levels. Multivariate statistical approaches like Pearson correlation, the principal component analysis (PCA) and the hierarchical cluster analysis (HCA) were applied to investigate the correlation between the radionuclides and the corresponding radiological hazard variables. Based on the statistical analysis, the 226Ra and 232Th mainly contribute to the radioactive risk of beach sand. Finally, no significant risk of the public associated with utilizing beach sand in building materials.

Serological and Histopathological Investigation of Chlamydia abortus in Aborted Ewes in Wasit, Iraq.

Chlamydia abortus is one of the most important pathogens, which causes a marked economic loss in small ruminants, in particular sheep, worldwide. This study aimed to detect the prevalence of C. abortus in the sera of aborted ewes in Wasit province, Iraq, using the enzyme-linked immunosorbent assay (ELISA), followed by the investigation of the main histopathological alterations that occurred in some organs of the dead newborns. Out of 180 tested samples by ELISA, 32.22% of the evaluated animals showed positive reactions to IgG antibodies toward C. abortus. Concerning the titers of the infection of seropositive ewes, there were significant increases in values of moderate level of antibody titer (55.17%), compared to mild (32.76%) and severe (12.07%) levels of infection. History data showed a significant variation (P<0.05) in the existence of seropositive ewes with other field animals. However, significant increases (P<0.05) were reported in the seropositive ewes existed with goat (91.38%) and cattle (84.48%), while significant decreases (P<0.05) were observed in positive ewes found in donkeys (8.62%), horses (3.45%), and camels (0%). Regarding the histopathology results, the findings of the small intestine showed marked necrosis of intestinal villous, hyperplastic tissues, and necrosis in some mucosal glands; however, in the liver, there was small ductal proliferation with mild portal fibrosis, necrotic debris, and focal areas of hemorrhage in the parenchyma. In conclusion, the findings of this study represent the first Iraqi data concerning Chlamydial detection in aborted ewes; however, further studies in other regions and animal species are necessary to know the actual prevalence of organisms and initiate active measures for control and prevention.

Biological control of Phlebotomus papatasi larvae by using entomopathogenic nematodes and its symbiotic bacterial toxins.

The sand fly Phlebotomus papatasi is an important disease-bearing vector. Five entomopathogenic nematodes (EPNs) - Steinernema carpocapsae DD136, Steinernema sp. (SII), S. carpocapsae all, S. abbasi, and Heterorhabditis bacteriophora HP88 - were applied as biocontrol agents against the late third instar larvae of P. papatasi. In addition, the effect of toxin complexes (TCs) of Xenorhabdus nematophila and Photorhabdus luminescens laumondii bacteria was evaluated. Results revealed that S. carpocapsae DD136 was the most virulent species followed by Steinernema sp. (SII) and S. carpocapsae all where LC50 were 472, 565, 962 IJs/ml, respectively. Also, the crude TCs were slightly more active and toxic than their fractionated protein. Histopathological examination of infected larvae with H. bacteriophora HP88 showed negative effect on their midgut cells. In conclusion, EPNs with their symbiotic bacteria are more effective as biocontrol agents than the crude or fractionated TCs against sand fly larvae.

Biological control of Phlebotomus papatasi larvae by using entomopathogenic nematodes and its symbiotic bacterial toxins

@# The sand fly Phlebotomus papatasi is an important disease-bearing vector. Five entomopathogenic nematodes (EPNs) – Steinernema carpocapsae DD136, Steinernema sp. (SII), S. carpocapsae all, S. abbasi, and Heterorhabditis bacteriophora HP88 – were applied as biocontrol agents against the late third instar larvae of P. papatasi. In addition, the effect of toxin complexes (TCs) of Xenorhabdus nematophila and Photorhabdus luminescens laumondii bacteria was evaluated. Results revealed that S. carpocapsae DD136 was the most virulent species followed by Steinernema sp. (SII) and S. carpocapsae all where LC50 were 472, 565, 962 IJs/ml, respectively. Also, the crude TCs were slightly more active and toxic than their fractionated protein. Histopathological examination of infected larvae with H. bacteriophora HP88 showed negative effect on their midgut cells. In conclusion, EPNs with their symbiotic bacteria are more effective as biocontrol agents than the crude or fractionated TCs against sand fly larvae.

Comparison of 1- and 2-day protocols for myocardial SPECT: a Monte Carlo study.

BACKGROUND: Myocardial perfusion single-photon emission computed tomography (SPECT) is carried out by combining a rest and a stress study that are performed either on one day or two separate days. A problem when performing the two studies on 1 day is that the residual activity from the first study contributes to the activity measured in the second study. AIM: Our aim was to identify and evaluate trends in the quantification parameters of myocardial perfusion images as a function of separation time between rest and stress. METHODS: A digital phantom was used for the generation of heart images and a Monte Carlo-based scintillation camera program was used to simulate SPECT projection images. In our simulations, the rest images were normal and the stress images included lesions of different types and localization. Two programs for quantification of myocardial perfusion images were used to assess the different images in an automated and objective way. RESULTS: The summed difference scores observed with the 2-day protocol were 3 +/- 1 (mean +/- SD) higher for AutoQUANT and 2 +/- 1 higher for 4D-MSPECT compared with those observed with the 1-day protocol. The extent values were 2% points higher for the 2-day protocol compared with the 1-day protocol for both programs. CONCLUSIONS: There are differences in the quantitative assessment of perfusion defects depending on the type of protocol used. The contribution of residual activity is larger when a 1-day protocol is used compared with the 2-day protocol. The differences, although small, are of a magnitude that results in a clear shift in quantification parameters.

Nodular fasciitis of the infraorbital rim in an adult patient.

STATEMENT OF THE PROBLEM: Nodular fasciitis is a fibroblastic proliferation in which nodules develop rapidly. It most commonly affects the extremities followed by the trunk and occasionally the head and neck. MATERIALS & METHODS: Case report. RESULTS: A 32-year-old male was seen with a 4-month history of a painless infraorbital mass. On examination, a swelling was palpable anterior to the left infraorbital rim. There was some depression of the left corner of his mouth. Computerized tomography showed soft tissue swelling anterior to the left maxillary antrum which, also, appeared to be diseased. The mass was thought to be malignant owing to the short history, associated facial asymmetry and maxillary sinus opacity. Excisional biopsy was performed. Histology proved it to be nodular fasciitis. CONCLUSIONS: The importance of otolaryngologists being aware of this entity is stressed. Simple excision, as tissue sparing as possible, is the treatment of choice.

Myofibroblastoma of breast: evidence favoring smooth-muscle rather than myofibroblastic differentiation.

A histopathological study of two cases of the tumor known in the literature as myofibroblastoma of the breast is presented. The tumors occurred in Caucasian males aged 57 and 62 years. Histologically, these were moderately cellular, lobulated spindle-cell lesions, each with a reasonably well-delineated edge with surrounding fatty connective tissue. No breast ducts or lobules were present. Tumor cell nuclei were bland, with small nucleoli and some nuclear grooving. Nuclear atypia and mitoses were absent. Immunostaining revealed positivity for a-smooth-muscle actin, desmin, and CD34. Tumor cells contained rough endoplasmic reticulum, bundles of myofilaments with focal densities, intermediate filaments, attachment plaques alternating with plasmalemmal caveolae, and focal lamina. Ultrastructural findings pointed to true smooth-muscle differentiation, and the cell-surface in particular lacked surface features of myofibroblasts (fibronectin fibrils [microtendons] and fibronexus junctions). These and published data suggest that at least some of the lesions referred to in the literature as myofibroblastoma may not be myofibroblastic and may be better designated as myogenic stromal tumors or as variants of leiomyoma.

A comparison of the intubation conditions between mivacurium and rocuronium during balanced anesthesia.

BACKGROUND: Comparisons of the intubation conditions with mivacurium and rocuronium from previous reports are confounded by the use of varied induction regimens. The authors compared intubation conditions of mivacurium, rocuronium, and a placebo at 90 s and their recovery profiles during anesthesia with nitrous oxide, oxygen, and propofol. METHODS: After induction with midazolam, fentanyl, and propofol in a randomized blinded study, 100 patients received one of the following treatments: 0.25 mg/kg mivacurium in divided doses (0.15 mg/kg followed by 0.1 mg/kg 30 s later); 0.45, 0.6, 0.9, or 1.2 mg/kg rocuronium; or placebo. Evoked thumb adduction was measured throughout. Intubation was attempted 90 s after the initial dose of mivacurium and other treatment doses by a "blinded" physician. Intubating conditions were graded as excellent, good, poor, or not possible. Spontaneous recovery was studied until a 25% initial twitch height was reached. Mean arterial blood pressure and heart rate changes between groups were determined before induction through 6 min after administration of the study drugs. RESULTS: There were no important changes or intergroup differences in mean arterial blood pressure and heart rate. Intubation conditions were good or excellent for both mivacurium and rocuronium at the 0.9 mg/kg dose (93%) and at the 1.2 mg/kg dose (100%). Rocuronium at the 0.6 mg/kg dose was excellent in 27% of patients, whereas rocuronium at the 0.45 mg/kg dose had the least number of excellent conditions and the most poor or not possible assessments. Patients given placebo could not be intubated. Times to maximum blockade for 0.9 and 1.2 mg/kg rocuronium were the shortest. The times to 25% recovery for 0.6 mg/kg rocuronium (mean +/- SD = 27 +/- 8.6 min), 0.9 mg/kg (43.1 +/- 10.8), and 1.2 mg/kg (62.3 +/- 17.4 min) were significantly longer than were those for mivacurium (17.4 +/- 6.2 min). CONCLUSIONS: Mivacurium in a 0.25 mg/kg divided dose and rocuronium at 0.9 mg/kg and 1.2 mg/kg provide good or excellent intubation conditions at 90 s in most patients. Rocuronium was faster in onset at the higher doses (0.9 and 1.2 mg/kg) but had more prolonged recovery times to 25% single twitch height.

Efficacy and safety of divided dose administration of mivacurium for a 90-second tracheal intubation.

STUDY OBJECTIVE: To compare the safety and effectiveness of 0.25 mg divided doses of mivacurium chloride to succinylcholine for a 90-second tracheal intubation. DESIGN: Randomized, double-blind, multicenter study in two groups. SETTING: Operating rooms at four university medical centers. PATIENTS: 200 healthy ASA status I and II adult patients scheduled for elective surgery with general anesthesia and endotracheal intubation. INTERVENTIONS: Patients were premedicated with 1 to 2 mg midazolam and 2 micrograms/kg fentanyl. Anesthesia was induced with 2 mg/kg propofol. Group A received 0.25 mg/kg mivacurium given as a divided dose (0.15 mg/kg followed in 30 seconds with 0.1 mg/kg). Group B (control) received 1.5 mg/kg succinylcholine (SCh) preceded two minutes earlier by 50 micrograms/kg d-tubocurarine (dtc). MEASUREMENTS AND MAIN RESULTS: Tracheal intubation grading, train-of-four response of the adductor pollicis, heart rate (HR), and mean arterial blood pressure (MAP) were measured and evaluated. Chi-square analysis was performed for comparison between Group A and Group B with respect to the frequency distribution of intubation using the scores excellent, good, and poor and not possible (combined). Group B had a significantly higher excellent score of intubation than Group A, 84% versus 56% (p < 0.0001). No significant difference was found between the two groups when the scores excellent and good were combined (Fisher's Exact test, p = 0.28). The changes in MAP and HR were similar for the two groups. CONCLUSIONS: When Sch is not desirable, mivacurium 0.25 mg/kg given as a divided dose provides good to excellent intubation conditions 90 seconds after the initial dose without significant changes in MAP or HR. It can be an appropriate alternative for short surgical procedures. It must be emphasized that this conclusion does not apply to rapid-sequence induction-intubation.

Malignant peripheral nerve sheath tumour with vascular differentiation: a report of four cases.

Four cases of malignant peripheral nerve sheath tumour showing vascular differentiation are described. One case was associated with neurofibromatosis 1 and contained angiosarcomatous, cartilaginous and rhabdomyoblastic elements. The other cases occurred in patients without neurofibromatosis and showed a spectrum of vascular lesions ranging from lobulated, haemangioma-like structures to angiosarcoma. These are the first recorded examples of this phenomenon not associated with neurofibromatosis. Immunohistochemical examination demonstrated the endothelial nature of the lesions in all cases and revealed cells positive for alpha-smooth muscle actin, probably pericytes, closely apposed to the endothelium.

Intra-arterial chemotherapy in patients with breast cancer: a feasibility study.

The aim of this study was to assess the practicality of treating patients with various stages of breast cancer by means of regional (intra-arterial) chemotherapy. Three groups of patients received a median of four (range 2-4) cycles of combination chemotherapy: group I operable primary (n = 10); group II, locally advanced disease (n = 20); group III, recurrent locoregional disease (n = 22). The response rates (complete response, partial response and mixed response) in these groups of patients were 100% in groups I and II and 86% in group III. Morbidity included drug streaming and dysaesthesia in the hand. Patients in groups I and II had their tumours downstaged, allowing surgery to be performed. Local control was also achieved in group III when other treatment modalities had failed.

Assessment of patient position for fiberoptic intubation using videolaryngoscopy.

STUDY OBJECTIVE: To compare laryngoscopic appearance obtained during flexible fiberoptic laryngoscopy with the patient's atlanto-occipital joint in the neutral and extended positions. DESIGN: Controlled clinical trial with each patient (in the neutral position) acting as his or her own control. SETTING: University teaching hospital. PATIENTS: 20 adult ASA physical status I and II patients, without anatomical airway abnormalities, undergoing elective surgical procedures. INTERVENTIONS: Fiberoptic laryngoscopy was performed on each patient with his or her atlanto-occipital joint in the neutral and extended positions. MEASUREMENTS AND MAIN RESULTS: Photographs of the laryngoscopic appearances were graded on a scale of 1 to 4 by a blinded observer according to the proportion of the laryngeal inlet visible. Atlanto-occipital extension improved laryngoscopic appearance in 14 cases and produced no change in the remaining 6. CONCLUSION: Atlanto-occipital extension is a useful maneuver during attempted fiberoptic intubation.

Using the laryngeal indices caliper to predict difficulty of laryngoscopy with a Macintosh #3 laryngoscope.

STUDY OBJECTIVE: (1) To evaluate a device of the authors' design, the laryngeal indices caliper, which quantitates the position of the anterior edges of the larynx relative to the upper teeth and the external auditory canals; (2) to determine how relative laryngeal position affects ease of direct laryngoscopy with a Macintosh #3 laryngoscope. DESIGN: Randomized, double-blind study. SETTING: Inpatient surgery center at a university medical center. PATIENTS: 101 renal lithotripter patients. INTERVENTIONS: Patients were measured with the laryngeal indices caliper prior to induction of general endotracheal anesthesia. They were then given a sleep dose of thiopental sodium (4 mg/kg) and paralyzed with a bolus dose of succinylcholine (1 mg/kg). MEASUREMENTS AND MAIN RESULTS: Of the measurements taken or calculated, only laryngeal tilt (LT) showed a significant correlation with grade of difficulty of laryngoscopy. When the anterior surface of the thyroid cartilage was tilted more than 20 degrees anteriorly to a line perpendicular to the laryngeal indices line, the vocal cords could not be seen in 83% of the patients. CONCLUSIONS: (1) Laryngeal tilt is a good predictor of difficulty of laryngoscopy with a Macintosh #3 laryngoscope; (2) the laryngeal indices caliper is a simple pocket device to measure LT indirectly.

Using the bubble inclinometer to measure laryngeal tilt and predict difficulty of laryngoscopy.

STUDY OBJECTIVE: To evaluate a simple device, the bubble inclinometer, to measure degrees of laryngeal tilt (LT) for predicting difficulty of direct laryngoscopy using a Macintosh #3 laryngoscope. DESIGN: Randomized, double-blind study. SETTING: Inpatient surgery center at a university medical center. PATIENTS: 50 renal lithotripter patients. INTERVENTIONS: Patients were measured with the bubble inclinometer and the laryngeal indices caliper. A sleep dose of thiopental sodium (4 mg/kg) and a muscle-relaxing dose of succinylcholine (1 mg/kg) were then given to each patient. MEASUREMENTS AND MAIN RESULTS: LT was measured by both methods (directly and indirectly). Difficulty of laryngoscopy was graded as follows: Grade 1 = all of vocal cords seen; Grade 2 = part of vocal cords seen; Grade 3 = no part of vocal cords seen. CONCLUSIONS: The bubble inclinometer accurately and reproducibly measures relative LT, and the anterior tilt of the larynx directly correlates with the ability to see the laryngeal opening during direct laryngoscopy with a Macintosh #3 laryngoscope.