Early Versus Delayed Laparoscopic Cholecystectomy, after Percutaneous Gall Bladder Drainage, for Grade II Acute Cholecystitis TG18 in Patients with Concomitant Cardiopulmonary Disease.

Background: The advancement in medical care has led to an increase in patients with acute cholecystitis (AC) and cardiopulmonary comorbidities referred for surgery. Grade II AC, according to Tokyo Guidelines in 2018 (TG18), is characterized by severe local inflammation with no systemic affection. The optimal treatment for patients with high-risk grade II AC has not yet been clearly established, which is still a dilemma. For these patients, laparoscopic cholecystectomy (LC), despite being the only definitive treatment, is still a challenge. The introduction of percutaneous cholecystostomy as a temporary minimally invasive alternative technique allows an immediate gallbladder decompression with a rapid clinical improvement. However, the next step after percutaneous transhepatic gall bladder drainage (PTGBD) in these high-risk patients is still a debate, with no definitive consensus about the ideal treatment of choice as well as its optimal timing. In our study, we followed a treatment algorithm for high-risk patients that involved early gallbladder decompression by PTGBD, followed by LC at different intervals once the patient is considered fit for surgery. Method: A retrospective study of 58 patients with high-risk grade II AC with cardiopulmonary comorbidity from our medical records was included. They were managed initially with PTGBD, an LC was then performed either within 7 days after drain insertion (early group, 26 patients), while an LC was performed later for the remaining patients within 6-8 weeks after PTGBD (late group, 32 patients). The results of the two groups were analyzed. Result: Procalcitonin and C-reactive protein were significantly higher in the late group. No significant difference was found between both groups with regard to operative time, PTGBD-related complications, and major perioperative complications. Timing after PTGBD did not affect the incidence of operative complications. Total hospital stay was significantly shorter in the early group. Conclusion: PTGBD is a safe initial intervention for high-risk patients with AC with a low morbidity and high success rate. Urgent LC after PTGBD can be performed safely for well-selected high-risk patients with the timing of surgery is personalized according to each patient's clinical situation. Early LC (after PTGBD) has the advantage of shorter hospital stay, low cost, as well as avoiding the risk of biliary complications and mortality if waiting a delayed surgery with no significant difference in morbidity compared with late LC.

Revisional One-Step Bariatric Surgical Techniques After Unsuccessful Laparoscopic Gastric Band: A Retrospective Cohort Study with 2-Year Follow-up.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has high reported rates of revision due to poor weight loss (WL) and high complication rates. Yet, there is yet to be a consensus on the best revisional procedure after unsuccessful LAGB, and studies comparing different revisional procedures after LAGB are still needed. METHODS: This was a retrospective cohort study that compared the outcomes of one-step revisional Roux-en-Y gastric bypass (rRYGB), one-anastomosis gastric bypass (rOAGB), or laparoscopic sleeve gastrectomy (rLSG) after LAGB. WL, complications, resolution of associated medical conditions, and food tolerance were assessed with a post hoc pairwise comparison one-way analysis of variance (ANOVA) throughout a 2-year follow-up. RESULTS: The final analysis included 102 (rRYGB), 80 (rOAGB), and 70 (rLSG) patients. After 2 years, an equal percentage of excess weight loss was observed in rOAGB and rRYGB (both >90%; p=0.998), significantly higher than that in rLSG (83.6%; p<0.001). In our study, no leaks were observed. rRYGB had higher complication rates according to the Clavien-Dindo classification (10.8% vs. 3.75% and 5.7% in rOAGB and rLSG, respectively, p=0.754), and re-operations were not statistically significant. Food tolerance was comparable between rOAGB and rRYGB (p = 0.987), and both had significantly better food tolerance than rLSG (p<0.001). The study cohorts had comparable resolution rates for associated medical problems (p>0.60). CONCLUSION: rOAGB and rRYGB had better outcomes after LAGB than rLSG regarding WL, feasibility, food tolerance, and safety. rOAGB had significantly higher rates of nutritional deficiencies.

OPG/RANK/RANKL axis relation to cardiac iron-overload in children with transfusion-dependent thalassemia.

OPG/RANK/RANKL axis was reportedly involved in initiating various diseases, especially bone and cardiovascular diseases. This study aimed to assess the relationship between some OPG, RANK, and RANKL polymorphisms and alleles and iron-overload-induced cardiomyopathy in children with transfusion-dependent thalassemia (TDT). This study included 80 TDT children and 80 age and sex-matched controls. Real-time PCR was done for rs207318 polymorphism for the OPG gene and rs1805034, rs1245811, and rs75404003 polymorphisms for the RANK gene, and rs9594782 and rs2277438 polymorphisms for the RANKL gene. Cardiac T2* MRI and ejection fraction (EF) were done to assess the myocardial iron status and cardiac function. In this study, there were no significant differences in frequencies of the studied polymorphisms between cases and controls (p > 0.05 in all). In TDT children, OPG rs2073618 (G > C) had a significant relation to myocardial iron overload (p = 0.02). Its C allele had significantly more frequent normal EF than its G allele (p = 0.04). RANK rs75404403 (C > DEL) had a significant relation to cardiac dysfunction (p = 0.02). Moreover, the C allele of that gene had significantly more frequent affected EF than its DEL allele (p = 0.02). The A allele of RANKL rs2277438 (G > A) had significantly less frequent severe cardiac iron overload than the G allele (p = 0.04). In conclusion, the OPG/ RANK/RANKL genes may act as genetic markers for iron-induced cardiomyopathy in TDT children. Some of the studied genes' polymorphisms and alleles were significantly related to myocardial iron overload and cardiac dysfunction in TDT children.

Estimation of Cadmium in Muscles of Five Freshwater Fish Species from Manzalah Lake, and Possible Human Risk Assessment of Fish Consumption (Egypt).

The Egyptian government devised a plan in 2016 to improve the unique ecological significance of northern lakes, which mentioned Manzalah Lake in the Egypt Vision 2030. In this regard, this study investigated cadmium (Cd) content in five freshwater fish species collected from Manzalah Lake in Egypt at 2018 by local fishermen. According to the findings, Clarias gariepinus recorded the highest concentration of Cd (1.40 ± 0.2 µg/g) and the lowest concentration was recorded in O. aureus (1.19 ± 0.2 µg/g). Cadmium contents of all species were largely above the permissible level of the Food Agricultural Organization (FAO)/World Health Organization (WHO) and Commission Regulation (EC). The estimated daily intake (EDI), the estimated weekly intake (EWI), and the percentages of provisional tolerable weekly intake (PTWI %) values for Cd in the C. gariepinus > Sarotherodon galilaeus > Tilapia zillii > Oreochromis niloticus > Oreochromis aureus which consumed by children, teenagers, and adults were much higher than the PTWI values established by FAO/WHO. In addition, C. gariepinus consumed by children showed the highest value of the target hazard quotient (THQ) (5.83 a day or 40.81 a week) while O. aureus that ingested by adults showed the lowest level (1.06 a day or 7.42a week). The target carcinogenic risk (TCR) of C. gariepinus in children had the greatest level (2.21 × 10-3 a day or 1.55 × 10-2 a week), whereas O. aureus in adults had the lowest level of TCR (4 × 10-4 a day or 2.81 × 10-3 a week). THQs values of Cd in the five studied species were found higher than one. Moreover, TCRs values of Cd in the five species were exceeded the US Environmental Protection Agency guideline USEPA permissible limits suggesting that a daily or weekly consumption of these species could lead to a high risk non-carcinogenic and carcinogenic for humans.

The health risk assessment of heavy metals to human health through the consumption of Tilapia spp and catfish caught from Lake Mariut, Egypt.

This work assesses the concentration of As, Cd, Pb, Hg, and Al in three of Tilapia species and catfish caught from Lake Mariut. As well as the human health risk and muscle biochemical composition. Besides, the antioxidant responses of different species. The average metal concentration order was Pb> As> Cd> Al> Hg. The Cd and Pb levels in all species; besides, the Hg levels in Oreochromis niloticus and Oreochromis aureus exceeded the maximum limits set by FAO, European legislation, and FAO/WHO. The human health risk was assessed using estimated dietary intakes, the target hazard quotient (THQ), and the carcinogenic risk (CR). THQAs was >1 in all examined fishes and closer to 1 in THQCd, Hg. As well, CR level for As was higher than the permissible value. Tilapia zillii showed significant decreases in carbohydrates compared to Clarias gariepinus; also, ash content compared to C. gariepinus, O. niloticus, and O. aureus. Furthermore, water content compared to O. aureus. In contrast, significant increases of SOD in O. niloticus compared to C. gariepinus. In addition, CAT and GPx in O. aureus compared to C. gariepinus. Also, GR in both O. niloticus and O. aureus compared to C. gariepinus, and GSH in all of Tilapia spp. compared to C. gariepinus. Data obtained provide evidence of health risks to the consumers. Therefore, more caution is required.

RANK/RANKL/OPG axis genes relation to cognitive impairment in children with transfusion-dependent thalassemia: a cross-sectional study.

BACKGROUND: RANK/RANKL/OPG axis was implicated in many pathological conditions. The study aimed to assess the relationship between the studied RANK, RANKL, and OPG polymorphisms and alleles and cognitive impairment in children with transfusion-dependent thalassemia (TDT). METHODS: This study included 60 TDT children. Real-time PCR was done for: rs1805034, rs1245811, and rs75404003 polymorphisms for the RANK gene, rs9594782 and rs2277438 polymorphisms for the RANKL gene, and rs207318 polymorphism for the OPG gene. The intelligence quotient (IQ) was assessed using the Wechsler Intelligence Scale for Children-Third Edition. RESULTS: TDT children had a low average total IQ, verbal IQ, and borderline performance IQ. RANK rs1805034 (C > T) had a significant effect on total IQ (p = 0.03). Its TT polymorphism and the CT polymorphism of RANKL rs9494782 (C > T) had a significantly lower total IQ (p = 0.01 for both). The G allele of the RANKL rs2277438 (G > A) had a significantly lower total IQ (p = 0.02). RANK rs1805034 (C > T) and RANKL rs2277438 (G > A) significantly affected verbal IQ (p = 0.01 and 0.03). TT genotype of RANK rs1805034 (C > T) had significantly lower verbal IQ (p = 0.002). Furthermore, the GG genotype of RANKL rs2277438 (G > A) had a significantly lower verbal and performance IQ than the AA genotype (p = 0.04 and 0.01 respectively), and its G allele had a significantly lower performance IQ than the A allele (p = 0.02). CONCLUSION: TDT children had low average total and verbal IQ while their performance IQ was borderline. The RANK/RANKL/OPG pathway affects cognition in TDT children, as some of the studied genes' polymorphisms and alleles had significant effects on total, verbal, and performance IQ of the studied TDT children.

Comparison of the mid-term outcomes of banded and non-banded sleeve gastrectomy: safety, food tolerance, and weight regain.

BACKGROUND: Long-term weight regain (WR) after sleeve gastrectomy (SG) is a major challenge. Laparoscopic banded SG (BSG) was introduced to overcome pouch dilation and, consequently, WR; however, its mid-and long-term outcomes have not been sufficiently demonstrated. OBJECTIVE: This study retrospectively evaluated the mid-term weight loss efficacy and morbidity over at least a 4-year follow-up after laparoscopic banded SG using a MiniMizer Gastric Ring® and laparoscopic non-banded SG. METHOD: The data of 1586 bariatric surgeries were retrospectively evaluated. To ensure homogeneity in our study cohort, propensity score matching (PSM) was performed. RESULTS: The final cohort comprised 1392 patients: the non-banded SG (n = 1260) and BSG (n = 132) groups. In our matched cohort (SG, n = 655 and BSG, n = 132), WR was noted in 4 (3.0%) and 71 (10.8%) patients in the BSG and SG groups, respectively. Gastric band erosion or slippage was not noted in the BSG cohort. The levels of cholesterol and triglyceride were similar in the two groups. Postoperative glycemic control was significantly reduced in the BSG group. CONCLUSION: Although the percentage of weight loss achieved in the BSG group was low in the first year postoperatively, the mid-term (sustained) weight loss associated with BSG was superior to that associated with non-banded SG. BSG is a safe procedure with no significant mid-term band-related morbidity; its impact on the resolution of comorbidities is equivalent and perhaps superior to SG.

The Relationships between Gender, Life Satisfaction, Loneliness and Problematic Internet Use during COVID-19: Does the Lockdown Matter?

In response to the COVID-19 pandemic, many governments have attempted to reduce virus transmission by implementing lockdown procedures, leading to increased social isolation and a new reliance on technology and the internet for work and social communication. We examined people's experiences working from home in the UK to identify risk factors of problematic internet use during the first lockdown period, specifically looking at life satisfaction, loneliness, and gender. A total of 299 adults completed the Problematic Internet Use Questionnaire-Short-Form-6, UCLA-3 Item Loneliness Scale, and Satisfaction with Life Scale online. Through structural equation modelling, we found that loneliness positively predicted problematic internet use while gender had no effect. Life satisfaction and age positively predicted loneliness but had no direct effect on problematic internet use, suggesting loneliness fully mediated their relationship with problematic internet use. Our study serves as a benchmark study of problematic internet use among those working from home during lockdown conditions, which may be utilized by future researchers exploring longitudinal patterns post-pandemic.

External validation of the French alpha-fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort - a retrospective study.

Prognostic models of liver transplantation (LT) for hepatocellular carcinoma (HCC) mainly derive from LT cohorts with numerous hepatitis C virus (HCV) patients. The AFP model, which is currently used in France to select LT candidates, was derived from a cohort of LT performed between 1988 and 2001, including a majority of HCV-positive recipients. The emergence of new direct-acting antiviral therapies and subsequent decrease of HCV incidence may change the generalizability of such models. We performed an external validation of the AFP model in a cohort of recipients transplanted between 2005 and 2018. Although multivariable analysis identified all three model's factors (AFP level, largest tumor size, number of nodules) as predictors of tumor recurrence, the AFP model showed poor discrimination and calibration in the present cohort. This poor performance could be related to significant differences between the derivation and the present cohort in terms of etiology, severity of underlying liver disease, tumor burden and differentiation, and use of neoadjuvant treatments. The present findings suggest that the decline of HCV-induced HCC among LT candidates may compromise the generalizability of the AFP model in more recent LT cohorts. Further studies are required for updating or building more robust prognostic models.

Emerging therapeutic modality enhancing the efficiency of chemotherapeutic agents against head and neck squamous cell carcinoma cell lines.

The current work aimed to evaluate bee venom (BV) cytotoxic effect and its synergistic action when combined with cisplatin (CIS) against four types of head and neck squamous cell carcinoma (HNSCC) cell lines. 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assay for cell viability, reverse transcription-polymerase chain reaction (RT-PCR) for expression of BCL2 associated X (BAX), B-cell lymphoma 2 (BCL2) and epidermal growth factor receptor (EGFR) genes and, flow cytometry for cell cycle analysis were performed. MTT assay revealed that BV caused an approximately 50% cell death for UMSCC12, UMSCC29, UMSCC38 and, UMSCC47 cell lines after 72 hr with 54.809 µg/ml, 61.287 µg/ml, 71.328 µg/ml and, 61.045 µg/ml, respectively. RT-PCR demonstrated a significant up-regulation of BAX gene and a significant down-regulation of BCL2 and EGFR genes among single or combined treatments with CIS and BV as compared to vehicle-treated. The cell lines treated with both BV and CIS showed marked elevation of BAX and a notable drop of BCL2 and EGFR expressions than single-treated groups. Cell cycle analysis via flow cytometry revealed significantly increased cells in the G2/M phase in single or combined-treated cell lines with CIS and BV when compared with vehicle-treated. Moreover, a significant decrease in cells in S phases among all single and combined treatments when matched with vehicle-treated. Briefly, the findings of the present study suggest that BV can exert an anti-cancer effect on HNSCC and may have the potentiality for potentiation of CIS cytotoxic effects and reduction of its adverse effects.

Correction to: Trace elements exposure influences proximate body composition and antioxidant enzyme activities of the species tilapia and catfish in Burullus Lake-Egypt: human risk assessment for the consumers.

The correct images of figs. 2 and 3 are presented in this paper.

Trace elements exposure influences proximate body composition and antioxidant enzyme activities of the species tilapia and catfish in Burullus Lake-Egypt: human risk assessment for the consumers.

The trace elements concentration in the fish estimates the contamination degree in the aquatic environment. These toxic trace elements are transported into the human through the consumption of polluted fish. This study estimated the effect of Cd, Hg, Pb, As, and Al on tilapia species and catfish Clarias gariepinus (six for each species of fish) inhabiting Burullus Lake-Egypt 30° 33'-31° 08' E and 30° 22'-31° 35' N. The highest Pb concentrations recorded in the muscle of C. gariepinus 2.29 ± 0.29 µg/g while S. galilaeus was estimated the lowest Hg concentration of 0.54 ± 0.02 µg/g which indicated the presence of contaminants exceeded the limits permitted by FAO/WHO and EC. The maximum mean carbohydrate, lipid, and protein recorded in O. niloticus 18.66, 16.33, and 58.16 mg/g, respectively; moisture in O. aureus 67.33%; and ash 16.41% in O. niloticus. The lowest amount of carbohydrate was recorded in the T. zillii 14.1 mg/g, lipid, and ash in C. gariepinus 11.65 mg/g and 3.375%, respectively. Protein and moisture in the S. galilaeus were 53.75 mg/g and 60.75%, respectively. The results recorded a marked insignificant (P > 0.05) decrease in CAT, GR, and GPx activity in O. niloticus. GSH and SOD activity was an insignificant (P > 0.05) decrease in C. gariepinus. The results concluded that the trace elements concentrations exceed the maximum permissible limits recommended in fish samples set by Egypt, FAO, WHO, and EC. The estimated weekly intake of all elements through consumption of studied fish species inhabiting Burullus Lake by a child (15 kg) in Egypt is well above the PTWI recommended by FAO/WHO, whereas it is well below the PTWI for human consumption by young people (40 kg) and adult person (70 kg), at least in respect of residual levels of studied elements excluding Cd and Hg. Thus, for consumer protection, these fish species are unsafe and have hazardous effects for children, and about youth and adult consumption, caution must be taken to consider individuals eating significant amounts of fish.

Cholangitis lenta: An underdiagnosed lesion associated with severe cholestasis following liver transplantation.

BACKGROUND: Cholangitis lenta (CL) represents a specific histological lesion associated with severe cholestasis and related to sepsis. Despite being well known by pathologists, CL has been poorly studied in liver transplantation (LT). METHODS: We performed a retrospective 12-year analysis of the incidence, risk factors, and outcome of CL in LT recipients. Biopsy samples performed within 3 months after LT underwent blinded rereading to identify recipients with CL. RESULTS: Among 587 LT performed, 45 (7.7%) developed CL. Of these, 7 (15.6%) had no signs of clinical sepsis at the time of biopsy, but further investigations revealed positive cultures. Independent factors associated with CL were sepsis at the time of LT (OR = 3.62 [95%CI = 1.63-8.06]), donor age (OR = 1.05 [1.03-1.08]), and operative time (OR = 1.23 [95%CI = 1.02-1.48]). Cholangitis lenta was associated with increased severe morbidity (71.1% vs 33.0%, P < .001), 90-day mortality (24.4% vs 5.9%, P < .001) and decreased one-year graft (62.1% vs 89.4%, P < .001) and patient survival (55.6% vs 87.9%, P < .001). CONCLUSION: Cholangitis lenta represents a possible lesion associated with cholestasis after LT, which strongly affects its outcome. In the event of an unexplained post-transplant cholestasis, the diagnosis of CL must be considered, even in the absence of clinically evident sepsis.

Neoadjuvant conformal radiotherapy before liver transplantation for hepatocellular carcinoma: a propensity score matched analysis of postoperative morbidity and oncological results.

Aim: To assess neoadjuvant conformal radiotherapy (CRT) before orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) not suitable for standard locoregional treatments. Methods: Patients undergoing OLT for HCC with or without prior CRT were compared using 1:3 propensity score matching. Results: After propensity score matching, 23 patients with CRT were compared with 66 control subjects. Severe morbidity rate was 34.8 versus 24.2% in the CRT and non-CRT groups (p = 0.289). Complete pathological response was observed in 47.8% of CRT-targeted nodules. The 1-/3-/5-year disease-free survivals were 77.3, 77.3 and 68.7% in the CRT group versus 85.4, 68.0 and 61.7% in the non-CRT group (p = 0.829). Conclusion: Conformal radiotherapy represents a satisfactory neoadjuvant therapy for OLT candidates not suitable for standard HCC locoregional therapies.

MRI prognostic factors of tongue cancer: potential predictors of cervical lymph nodes metastases.

Background This study aimed to evaluate the efficacy of three MR imaging parameters, which are tumour thickness, para-lingual distance and apparent diffusion coefficient (ADC) value for prediction of cervical lymph nodes metastasis in cancer tongue patients. Patients and methods Fifty patients with proved cancer tongue by histopathological examination underwent MRI examination. T1 and T2- weighted MRI, diffusion-weighted images and post-contrast T1 fat suppression sequences were used. Results The patients were classified according to lymph nodes involvement as seen by MRI into two groups. Significant differences between positive and negative nodes groups were observed regarding tumour thickness and para-lingual distance (p-values = 0.008 and 0.003 respectively). ROC curve analyses revealed cut-off values >13.8 mm and ≤ 3.3 mm for tumour thickness and para-lingual distance respectively for prediction of nodes involvement. No significant differences between patients with and without cervical lymph nodes metastasis were found regarding corresponding ADC value of the tumour (p-value = 0.518). Conclusions Para-lingual distance and tumour thickness are factors that could influence pre-operative judgment and prognosis of tongue cancer patients. ADC value of the tumour itself seem not to be a reliable index of cancer progression to regional lymph nodes.

Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management of Pulmonary Hypertension in Mitral Valve Surgery. A Randomized Controlled Study.

OBJECTIVE: To compare the effects of dobutamine and nitroglycerin to milrinone in young patients with severe pulmonary hypertension undergoing mitral valve replacement. DESIGN: A prospective randomized, double-blinded, controlled study. SETTING: Single university hospital. PARTICIPANTS: Forty patients had systolic pulmonary arterial pressure ≥60 mmHg and were scheduled for elective mitral valve replacement. The patients were divided randomly into 2 equal groups according to the drugs given during the study. INTERVENTIONS: The patients in group I received 5 to 20 µg/kg/min of dobutamine and 0.5 to 3 µg/kg/min of nitroglycerin, and patients in group II received a loading dose of milrinone, 50 µg/kg over 10 minutes, followed by a maintenance dose of 0.25 to 0.75 µg/kg/min. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the effects of interventional drugs on mean pulmonary artery pressure. The secondary outcomes were the effects of interventional drugs on systemic and pulmonary hemodynamic parameters measured from induction of anesthesia until the first 12 hours in the intensive care unit stay. There was a more significant decrease in mean pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure in group II than group I at all time points after cardiopulmonary bypass. There were more significant increases in heart rate, mean arterial pressure, cardiac output, and mixed venous oxygen tension in group I than group II, which became more obvious in time. In both groups, there was a significant decrease in systemic vascular resistance and pulmonary vascular resistance at all times. CONCLUSION: Milrinone provides adequate cardiac performance, causing a greater reduction in pulmonary artery pressure and pulmonary capillary wedge pressure.

Effects of aqueous cinnamon extract on chemically-induced carcinoma of hamster cheek pouch mucosa.

This study aimed to investigate the effects of aqueous cinnamon extract (ACE) on 7, 12-Dimethylbenz[a]anthracene (DMBA)-induced oral carcinogenesis in hamster cheek pouch (HCP) mucosa. Sixty male Syrian hamsters were randomly divided into six equal groups. The hamsters of groups I, II and III received no treatment, DMBA and ACE respectively, for 16 weeks. Groups IV and V were handled as group II and concomitantly treated with ACE for the same period and additionally group V received ACE for other 16 weeks after the stoppage of DMBA application. Group VI hamsters were handled as group III and additionally received DMBA for other 16 weeks after the stoppage of ACE supplementation. Hamsters of each group were euthanized according to the experimental schedule. The buccal pouches were and prepared for H&E stain, PAS reagent, CD3 and PDGF immunohistochemical reactivity. All groups showed dysplastic changes with varying degrees except groups I and III. Deep invasive carcinomas were recorded in 90% of the samples of group II, 60% of group IV, 50% of group V and 40% of group VI. From the previous results, it can be concluded that ACE has the potentiality preventing oral cancer initiation better than inhibiting oral cancer progression.

A 19-Year-Old College Student With Headache, Photophobia, and Flulike Illness.

CASE PRESENTATION: A 19-year-old previously healthy man presented, minimally responsive, in respiratory distress to an ED after a 2-week history of headache, photophobia, and neck stiffness. Associated symptoms included low-grade fevers, malaise, and dark urine. He had no recent travel, ill contacts, consumption of undercooked meat, new sexual contacts, or illicit drug use. The patient resided in a campus dormitory and did not consume alcohol or tobacco.

Efficacy of azithromycin and metronidazole combined therapy on rats' gingival overgrowth induced by cyclosporine-A: An experimental animal study.

AIMS: To evaluate the therapeutic efficacy of azithromycin (azm) and/or metronidazole (mtz) on the histopathological features of rats' gingival overgrowth (GO) induced by cyclosporine-A (CsA) in an animal model. METHODS: Ninety male albino rats were divided randomly into six equal groups. The rats of group I received corn oil via gastric feeding for 7 weeks. Group II rats were administered CsA for the same period. Groups III, IV, and V rats received CsA for 6 weeks and simultaneously in the 7th week received a monotherapy of placebo gel, azm suspension, mtz gel, respectively. Group VI rats were handled as groups III, IV, and V and instead received a combined therapy of azm suspension, and mtz gel. Rats were euthanized at the end of the experiment and routine tissue processing was carried out. The obtained specimens were stained with H&E, TGF-ß, MMP-1, and IL-6 antibodies. RESULTS: One-way MANOVA test for TGF-ß, MMP-1, and IL-6 revealed an overall significant difference between the different groups (P = 0.000). LSD post hoc test for multiple comparisons of TGF-ß revealed nonsignificant difference between groups I and VI and between groups IV and V. Nonsignificant difference was found between groups II and III considering the amount of MMP-1 immune expression. In addition, nonsignificant difference was found between groups V and VI regarding the amount of immune expression for IL-6. CONCLUSION: Combined therapy of azm suspension and mtz gel significantly improved the histopathological features of CsA-induced GO better than a monotherapy of azm suspension or mtz gel.

The oncofetal protein IMP3 is an indicator of early recurrence and poor outcome in mucoepidermoid carcinoma of salivary glands.

OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common primary malignancy of the salivary glands. Insulin-like growth factor-II mRNA-binding protein-3 (IMP3) is an important prognostic factor in some cancers and a tool that differentiates between benign and malignant pancreatic lesions. This study aimed to identify a relationship between the expression of IMP3 and the outcome of salivary gland MEC, as well as to differentiate MEC from pleomorphic adenoma (PA). METHODS: Tissue specimens from 70 cases of salivary gland MEC, 40 cases of PA, and 10 cases with normal salivary gland were examined immunohistochemically for IMP3. The association among the expression of IMP3, clinicopathological characteristics and patient's survival was assessed. RESULTS: IMP3 was present in 51.4% of MEC but absent in PA and normal salivary gland tissues. IMP3 expression was associated with age > 60 years, submandibular gland tumors, tumor size > 4 cm, high-grade tumors, lymph node metastasis, involvement of surgical margins, perineural invasion, distant metastasis, advanced TNM stage, tumor relapse, and death ( P<0.05). Increased expression of IMP3, tumors of the submandibular gland, and lymph node metastasis were independent prognostic factors of -free survival (DFS). In addition, IMP3 was a strong predictor of overall survival (OS) together with distant metastasis and intermediate and high-grade tumors. CONCLUSIONS: IMP3 expression is highly important in evaluating the outcome of MEC. IMP3 can be used to differentiate MEC from PA of salivary glands.