Impact of a National Controlled Donation After Circulatory Death (DCD) Program on Organ Donation in the United Kingdom: A 10-Year Study.

Organ transplantation is the most successful treatment for some forms of organ failure, yet a lack of organs means many die on the waiting list. In the United Kingdom, the Organ Donation Taskforce was set up to identify barriers to organ donation and in 2008 released its first report (Organ Donation Taskforce Report; ODTR). This study assesses the success since the ODTR and examines the impact of the United Kingdom's controlled donation after circulatory death (DCD) program and the controversies surrounding it. There were 12 864 intended donation after brain death (DBD) or DCD donors from April 2004 to March 2014. When the 5 years preceding the ODTR was compared to the 5 years following, intended DCD donors increased 292% (1187 to 4652), and intended DBD donors increased 11% (3327 to 3698). Organs retrieved per intended DBD donor remained static (3.30 to 3.26), whereas there was a decrease in DCD (1.54 to 0.99) due to a large rise in donors who did not proceed to donation (325 to 2464). The majority of DCD donors who proceeded did so within 30 min from time of withdrawal. Our study suggests further work on converting eligible referrals to organ donation and exploring methods of converting DCD to DBD donors.

[Level of Binocular Pseudoaccommodation in Patients Implanted with an Apodised, Diffractive and Trifocal Multifocal Intraocular Lens]. / Grad der binokularen Pseudoakkommodation mit einer apodisierten, diffraktiven und trifokalen Multifokallinse.

PURPOSE: The aim of this study was to make an evaluation of the pseudoaccommodation span and clinical results after implantation of a diffractive, apodised and trifocal multifocal intraocular lens (MIOL). METHODS: In a prospective, single-centre study 28 eyes of 14 patients were evaluated after in the bag implantation of the Micro-F MIOL (PhysIOL, Belgium) during routine microsurgical cataract surgery. Two to four months postoperatively the final examinations were performed. Refraction, visual acuity monocular and binocular (near in 40 cm, intermediate in 80 cm and distance) as well as binocular defocus curves were evaluated. RESULTS: Mean monocular UDVA (uncorrected distance visual acuity) increased significantly (p < 0.0001) from 0.471 ± 0.22 logMAR to 0.144 ± 0.14 logMAR. For the monocular UNVA (uncorrected near visual acuity) and UIVA (uncorrected intermediate visual acuity) postoperative values of 0.127 ± 0.117 and 0.158 ± 0.20 logMAR compared to binocular results of 0.057 ± 0.137 and 0.094 ± 0.181 logMAR were found. In the analysis of the binocular defocus curve two peaks could be found between 0.0 and - 0.5 D with a visual acuity of 0.0 logMAR and at - 3.0 D with a visual acuity of 0.068 logMAR. In the intermediate range a constant pseudoaccommodation of 0.2 logMAR could be found. CONCLUSIONS: The trifocal, diffractive MIOL shows good functional results in all distances with a span of pseudoaccommodation of 3D and a mean visual acuity of 0.2 logMAR and better. Indeed it is offering a high level of spectacle independency without the typical intermediate gap of bifocal diffractive MIOLs.

A novel TaMYB4 transcription factor involved in the defence response against Puccinia striiformis f. sp. tritici and abiotic stresses.

MYB transcription factors are a large family of proteins involved in the regulation of secondary metabolism and cell shape, the enhancement of disease resistance and the response to different stresses. In this study, the role of TaMYB4 in wheat against biotic and abiotic stresses was investigated. TaMYB4 was cloned from wheat cv. Suwan11 [the leaves were infected with Puccinia striiformis f.sp. tritici (Pst)]; the TaMYB4 protein is 243 amino acids in length. In addition, TaMYB4 exhibited high similarity with BdMYB4 from Brachypodium distachyon, which was also identified as a member of the R2R3-MYB family of genes. Furthermore, transient expression analysis showed that the deduced TaMYB4 protein was localised in the nucleus of onion epidermal cells. Additionally, a yeast one-hybrid assay revealed that TaMYB4 exhibits transcriptional activity and the C-terminus is necessary for the activation of transcription. The transcript levels of TaMYB4 were observed directly and were found to be significantly upregulated in the early stage and 48 h after inoculation with the incompatible Pst. The transcripts of TaMYB4 were detected in the wheat roots, culms and leaves. Moreover, the transcription of TaMYB4 was induced by salicylic acid, ethylene, abscisic acid and methyl jasmonate hormones. The same results were obtained with cold and wound treatments. Furthermore, the knockdown of TaMYB4 expression using virus-induced gene silencing enhanced the susceptibility of wheat cultivar Suwon11 to the incompatible race of Pst. These results demonstrate that TaMYB4 plays a role in the wheat response to biotic stress.

Laparoscopic herniotomy in children: prospective assessment of tertiary center experience in a developing country.

PURPOSE: We aimed to assess prospectively the feasibility and outcome of laparoscopic herniotomy (LH) in children in a tertiary center with limited resources. METHODS: Fifty-six children with unilateral pediatric inguinal hernia (PIH) were treated for an 18-month period. All cases were subjected to LH in a way similar to the classic open technique following exploration of the contralateral patent processus vaginalis (CPPV) without ligation of the sac. Exclusion criteria included prematurity, age <6 months, irreducible or recurrent hernia, and cases with internal ring diameter >2 cm. Operative findings, postoperative results, and complications were assessed. RESULTS: We have 56 cases presented with unilateral PIH, and they are aged between 6 months and 15 years. Thirty-two presented with Rt hernia including 12 associated with CPPV and 24 cases Lt hernia with 10 associated with CPPV. Two cases showed adhesions and 2 cases showed direct defects that were repaired in the same session. Hydrocele of the hernia sac was reported once. In the total of 78 hernias, the mean operative time was 20.5 min in unilateral cases and 42.5 min in bilateral cases. No conversion was reported. Postoperative pain lasts for a mean time of 11.2 h. Patients regained peristalsis by a mean of 7 h. Two cases developed wound infection and were treated conservatively. No case of recurrence, testicular atrophy, or hydrocele was reported in the mean follow-up period of 20.5 months. CONCLUSIONS: Laparoscopic herniotomy is feasible and safe for PIH. It provides a superior tool to diagnose CPPV or rare hernias that can be managed in the same session with minimal postoperative complications reported even in developing countries. Laparoscopic herniotomy is proved to be beneficial for PIH since it provides an excellent view on the cord structures, and they can be guarded well during the procedure. Larger studies and longer follow-up are needed to support our encouraging results.

Fibro-osseous proliferation in the sternums and femurs of female B6C3F1, C57black and CD-1 mice: a comparative study.

Sternums and femurs from B6C3F1, C57black and CD-1 mice, used as controls in carcinogenicity studies, were microscopically examined for the presence of fibro-osseous proliferation (syn. hyperostosis, myelofibrosis, osteofibrosis). The uterus, vagina and ovaries of the same animals were microscopically examined, particularly for the morphological changes indicative of hyperestrogenism. The incidences of each finding in each strain were compared using a chi square test to detect any interstrain variations of statistical significance. Despite the markedly high incidence of endometrial cystic hyperplasia, vaginal epithelial cell hyperplasia and hyperkeratosis, which are morphological changes indicative of hyperestrogenism in all three strains of mice, the incidence of fibro-osseous proliferation in B6C3F1 mice was markedly higher than in the other two strains and statistically significant. This could be explained by a more sustained and higher level of endogenous estradiol in B6C3F1 mice, as brought into evidence by the markedly high, and stastically significant, incidence of follicular development/atresia, with cystic formation, in the ovaries of this strain. However, genetic factors that could determine the general predisposition to fibro-osseous proliferation in B6C3F1 mice cannot be ruled out.

Transbuccal permeation, anti-inflammatory activity and clinical efficacy of piroxicam formulated in different gels.

In attempts to avoid the systemic side effects of piroxicam (PC) (e.g. gastrotoxicity), several buccal gel formulations containing PC were prepared and their effects on the characteristics of the drug permeation through rabbit buccal mucosa in-vitro were evaluated using a Franz-type diffusion cell. The general rank order of the total flux of 0.5% PC from gels was found to be: hydroxypropylmethylcellulose (HPMC, 2.5%) > hydroxypropylcellulose (HPC, 2.5%) >or= sodium alginate (Na alg., 7%) > methylcellulose (MC, 3%) > hydroxyethylcellulose (HEC, 1.5%) > carbopol 934 (Carb. 934, 1%) >or= sodium carboxymethylcellulose (NaCMC, 2%) > pluronic F-127 (PF-127, 20%) > polyvinyl alcohol (PVA, 10%). The effect of various penetration enhancers 1% sodium lauryl sulphate (NaLS), 3% sodium deoxycholate (NaDC), 3% sodium tauroglycocholate (NaTGC) on the rate of permeation across the excised buccal mucosa (of 0.5% PC in gels prepared using 3% MC, 2.5% HPMC or 7% Na alg. base) and histology of the buccal epithelium was also investigated. Pharmacodynamic evaluation of the anti-inflammatory activity of PC in these gel formulations (containing 3% NaDC as an enhancer) was carried out using the kaolin-induced rat paw oedema method. The results obtained indicated that PC administered in 7% Na alg. or 2.5% HPMC gel bases was significantly more effective than the 3% MC gel and oral drug solution in suppressing oedema formation in rats. Comparative clinical studies were conducted in patients with post-operative dental pain and oedema following maxillofacial operations. The results revealed that 7% Na alg. and 2.5% HPMC gel formulations applied to the buccal mucosa were slightly better than or equally effective to the orally administered commercial product (Feldene Flash) tablet) in reducing pain level, swelling and tenderness within a period of 4 days. These findings suggest that PC (0.5%) administered in the buccal gel may present a potential therapeutical use as a strong anti-inflammatory and analgesic agent.

Cyclic changes in genital organs and vaginal cytology in cynomolgus monkeys (Macaca fascicularis).

Vaginal cytology was evaluated weekly over 12 months in 20 adult female Cynomolgus monkeys (Macaca fascicularis). After sacrifice of the animals the histology of the ovaries, uterus and vagina were studied in different phases of the menstrual cycle. The cytological examination of the vaginal smears showed that the superficial cells increased in number towards the middle of the cycle and the number of intermediate cells declined gradually. Parabasal cells were observed mainly at the beginning of the cycle; they disappeared towards the middle of the menstrual cycle. During the early follicular phase, the cells were moderately separated from each other, and during the second half of the proliferative or follicular phase, the superficial cells appeared clumped together. Leucocytes were usually absent except for at the beginning of the cycle and in the last few days of the late secretory or luteal phase. The maturation index of the vaginal smears can be considered as a tool for distinguishing the different phases of the menstrual cycle. The microscopic examination of the genital organs showed that during the proliferative or follicular phase of the cycle, which corresponds to the development of the ovarian follicles, the uterus showed growth of endometrial glands, stroma and endothelial cell proliferation with capillary sprouts. Shortly after ovulation and parallel to the formation of the corpora lutea, the endometrium enters the secretory or luteal phase, which is characterized by coiling of endometrial glands, glandular secretion and the differentiation of the spiral artery. The most striking changes in the vagina, is the marked basal cell proliferation and thickening of the stratum granulosum during the follicular phase of the menstrual cycle. The histological changes observed in the vagina demonstrated a good correlation with the observation on cytological examination of the smears. The present study demonstrated that the process of angiogenesis in the uterus during the different phases of the menstrual cycle is a multiple phenomenon involving proliferation, maturation and differentiation.

Long-term evaluation of modified lateral anorectal myomectomy for low-segment Hirschsprung disease.

OBJECTIVES: To provide a simple myomectomy technique for low-segment Hirschsprung disease and evaluate the efficacy of the new modification. DESIGN: Case series of 19 patients followed up for 12 to 56 months (mean, 39.1 months). SETTING: Tanta University Hospital, Tanta, Egypt. PARTICIPANTS: Nineteen patients aged 4 months to 10 years complaining of chronic constipation, with radiological and clinical data suggestive of low-segment Hirschsprung disease proven by histological examination. INTERVENTION: Modified lateral anorectal myomectomy. MAIN OUTCOME MEASURES: Clinical and radiological improvement measured by postoperative barium enema, bowel habits, and patient's relief of symptoms. RESULTS: Seventeen of 19 patients improved clinically and 13 showed radiological improvement 3 years postoperatively. There was poor response in 2 patients, who were subjected to further Soave procedures. CONCLUSION: Modified lateral anorectal myomectomy is an effective and technically simple procedure in patients suspected of having low-segment Hirschsprung disease.

Prevalence of hepatitis B and C in Egypt and Africa.

Hepatitis B and C are, and will remain for some time, major health problems in Egypt and the entire continent of Africa. Both infections can lead to an acute or silent course of liver disease, progressing from liver impairment to cirrhosis and decompensated liver failure or hepatocellular carcinoma (HCC) in a 20-30 year period. In addition, hepatitis B and C infection rates differ in different settings, and prognosis may be worse in conjunction with schistosomiasis in Egypt, malaria in Sudan and human immunodeficiency virus (HIV) in other African populations. Unlike hepatitis B virus (HBV), for which the prospects for controlling the spread of infection by vaccination are promising, prospects for development of an effective vaccine against hepatitis C virus (HCV) are limited. As well as screening of blood for transfusion and using sterile needles for injection, preventive measures should be undertaken to reduce the risk of contact (often described as community-acquired infection). Until more is known about the unidentified routes of transmission in tropical and subtropical settings it will be difficult to be specific about the kind of measures which may be effective. Success may largely depend on changing habits within the population. Prevention should be the main goal of current efforts until low-cost, effective therapies become available.

Diverse patterns of recognition of hepatitis C virus core and nonstructural antigens by antibodies present in Egyptian cancer patients and blood donors.

Serum samples from 429 cancer patients, 82 unpaid blood donors, and 74 paid blood donors were tested for hepatitis C virus (HCV) markers in two commercially available enzyme immunoassays (EIAs). A total of 229 of 429 (53.4%) cancer patients were positive by the two EIAs. A total of 34 of 156 (21.8%) of the blood donors were positive by the EIAs, with a higher prevalence among paid blood donors (20/74; 27%) compared with that among the unpaid blood donors (14 of 82; 17%). EIA-positive sera were tested for confirmation of the results in an immunoblot assay (LiaTek) in which reactivities to four synthetic peptides representing the HCV core protein and two synthetic peptides representing nonstructural proteins 4 and 5 were measured. Of 243 first and/or second EIA-positive samples from cancer patients, 188 (77.2%) were confirmed to be positive in the synthetic peptide immunoblot. A total of 33 of 35 (94.3%) blood donor samples were confirmed to be positive. A great diversity in reactivity patterns was seen. However, all sera from the group of paid blood donors were exclusively reactive to core peptides 1 and 2. A subset of LiaTek assay-positive samples were tested by the four-antigen RIBA-2 assay. The sera from the paid blood donors were all nonreactive. A subset of the LiaTek-positive sera was analyzed for the presence of the HCV genome by reverse transcriptase-PCR. Eleven of the 20 serum samples with reactivity to LiaTek core peptides 1 and 2 only were HCV reverse transcriptase-PCR positive, as were the majority of the sera with other reactivity patterns by the LiaTek assay. The results confirm the very high prevalence of HCV infection in Egypt. Furthermore, the results indicate that there is circulating in Egypt, particularly in the group of blood donors paid for their donation, an HCV variant which elicits an immune response that is not detected by the RIBA-2 assay.

Neoplastic and non-neoplastic lesions in the mammary gland, endocrine and genital organs in aging male and female Sprague-Dawley rats.

The non-neoplastic and neoplastic lesions in adrenals, thyroids, pituitary, uterus, ovaries, testes and mammary gland of senile untreated Sprague-Dawley rats were evaluated. The correlation between the neoplastic and non-neoplastic lesions in the pituitary gland and those in the target organs was made. The pituitary gland of the senile Sprague-Dawley rats had focal or diffuse hyperplasia and/or hypertrophy of PRL, STH, and ACTH cells. Approximately 47% of the males and 62% of the females had pituitary adenomas. Multiple adenomas in the same pituitary were noted in 7% of the males and in 11% of the females. Although many adenomas contained pleomorphic foci and quite a number of mitotic figures and were locally invasive, no evidence of distant metastases was discovered; therefore carcinoma was not diagnosed in the present material. The adenomas observed were divided into different types on the basis of the cytological characteristics of the cellular elements. Single cell-type adenomas such as PRL-, ACTH-, STH-, TSH-, immature- gonadotrophin-cell adenomas, and mixed cell (more than one cell type) adenomas were diagnosed. The adenomas containing PRL cells were the predominant type of neoplasms and they represented 30% and 34% of the total pituitary neoplastic lesions observed in males and females, respectively. The cytological changes in the hypophyseal cell types in senile Sprague-Dawley rats were usually accompanied by spontaneous non-neoplastic and neoplastic lesions in adrenals, thyroids, testes, ovaries, and mammary gland. The possible role of the hypophyseal hormones in the induction of the non-neoplastic and neoplastic lesions in the target organs is discussed. The combination of the spontaneous endocrine tumors could be associated both with aging and with genetic background of the animals. In addition, this polyglandular proliferative lesion in Sprague-Dawley rats might represent a potential model of mixed MEN syndrome.

Hepatic microsomal enzyme induction and thyroid function in rats treated with high doses of phenobarbital or chlorpromazine.

Rats were treated daily with high doses of phenobarbital or chlorpromazine for 6 weeks. The animals were sacrificed after 1, 2, 4 and 6 weeks of treatment. At each occasion, plasma levels of ASAT, ALAT, LDH, AP, total T4 and T3, free T4 and T3, and TSH were determined. The thyroids and liver weights were recorded, and the microscopical examination was performed on the liver, thyroids and pituitary gland. The results showed hepatic morphological changes indicative of enzyme induction on weeks 1, 2 and 4. During the first 4 weeks, plasma T4 and T3 were decreased in many individuals and increased in few others, and after 6 weeks of treatment the values for T4 and T3 returned to near normal. An increase in ASAT and ALAT was found at the same occasions. Follicular cell hypertrophy in the thyroids was observed during the first 4 weeks of treatment, in both treated groups, and after 6 weeks the thyroid glands returned to normal, except for a few individuals from the phenobarbital group. The present study has shown that the effect of phenobarbital and chlorpromazine on the thyroid gland function is predominantly due to their effect on the peripheral hormone disposition, as a result of the hepatic microsomal enzyme induction.

The immune status and response to measles vaccine amongst Egyptian infants. A preliminary report.

This study was carried out on 18 infants attending a primary care clinic in the Giza Governorate. Following a comprehensive history and physical exam estimation of measles antibody titer by neutralization testing was carried out on 10 infants prior to vaccination and on 8 infants prior to as well as one month following vaccination against measles utilizing the Edmondston-Zagreb strain. Our results indicate that at the currently adopted age of 9 months for vaccination, infants are susceptible to measles. Good response to vaccination with acquisition of immunity was noted despite border-line levels of growth and development. The occasional patient with persistent maternal antibodies to measles responded well to vaccination.

Thirteen-weeks subcutaneous treatment with high dose of natural sex hormones in rats with special reference to their effect on the pituitary-gonadal axis. I. Oestradiol.

A high dose of oestradiol (0.3 mg/kg/day) was administrated subcutaneously to male and female rats daily for 13 weeks. The effects of hormonal treatment on various parameters were studied. The results revealed that treatment with oestradiol resulted in alopecia, retarded hair regrowth, decreased body weight and food consumption and reduced Hb, PCV and total RBCs. Neutrophilic leucocytosis, elevated ESR, and decreased blood glucose levels were also observed. Atrophy of the ovaries, testes and secondary sex organs was also recorded. The uterus of the oestradiol treated rats displayed endometrial epithelial cell hyperplasia and hypertrophy of the myometrium. The pituitary gland of the rats with oestradiol had a significant increase in the number of PRL and ACTH cells together with cytological criteria indicative of increased secretory activity; the gonadotropin-producing cells showed involutionary changes. The mammary glands of the oestradiol treated rats showed maximal stromal and ductal proliferation and minimal acinar proliferation.

Thirteen-weeks subcutaneous treatment with high dose of natural sex hormones in rats with special reference to their effect on the pituitary-gonadal axis. II. Progesterone.

High dose of progesterone (25 mg/kg/day) was administered subcutaneously to male and female rats daily for 13 weeks. The effects of hormonal treatment on various parameters were studied. The results revealed increased food consumption associated with considerable weight gain in the progesterone-treated rats. Mucification of the vaginal epithelial cell lining, uterine involution and mild atrophy in the male genital organs were observed. The hypophyseal STH cells exhibited several cytological criteria typical of a pituitary cell-stimulated to accelerated activity; the PRL-, ACTH- and gonadotropin-producing cells were not affected. The mammary glands of the progesterone treated rats showed maximal acinar and minimal ductal and stromal cell proliferation.

Thirteen-weeks subcutaneous treatment with oestradiol or an oestradiol/progesterone combination in beagle bitches.

High doses of oestradiol (150 micrograms/kg) or an oestradiol/progesterone combination (150 micrograms/kg oestradiol plus 6.25 mg/kg progesterone) were administered subcutaneously on alternate days to immature ovariectomised and mature intact female Beagle dogs for 13 weeks. The effects of hormonal treatment on different parameters were studied. The results revealed severe anaemia (mainly at week 3) and the blood films showed morphological indication of blood loss and abnormal erythrogenesis. Neutrophil leucocytosis and non-progressive thrombocytopenia were also observed. Treatment with oestradiol alone induced changes in the endometrial stroma and myometrium, whereas treatment with the oestradiol/progesterone combination induced cystic endometrial hyperplasia. The pituitary glands of the dogs treated with oestradiol alone had a slight increase in the number of ACTH cells. These cells and STH cells showed cytological changes indicative of accelerated secretory activity; the PRL and gonadotropin-producing cells were not affected significantly. The oestradiol/progesterone combination increased the number of ACTH and PRL cells. These cells as well as STH cells exhibited several cytological criteria typical of a pituitary cell with accelerated activity; the gondadotropin-producing cells showed involutionary changes. The mammary glands of oestradiol-treated dogs showed stromal and ductal cell proliferation; whereas the oestradiol/progesterone combination induced secretory epithelial cell proliferation in addition to stromal and ductal cell proliferation.

Mercury content in some marine fish from the Alexandria coast.

The total Hg of 6 marine fish species, caught from the 3 main fishing grounds along the coast of Alexandria, was determined and the distribution among the different organs was studied. It was found that the total Hg levels in fish differed according to species, size, and organs of fish as well as fishing ground. The highest value was found in large size especially in the viscera of Mullus barbatus obtained from El-Mex fishing ground.

In-vitro study of physostigmine salicylate and pilocarpine hydrochloride release from different gel formulations.

Effect of methylcellulose and polyethylene glycol (PEG1 and PEG2) gel formulations on in-vitro release of combination of 0.25% w/w physostigmine salicylate and 1% w/w pilocarpine hydrochloride was investigated in comparison with a fatty base containing the same drugs by using a stationary dialysis technique. The results showed that the release of both drugs was very slow from the fatty base while a maximum release was attained from methylcellulose gel formulation followed by PEG1 and then PEG2 gel formulations as indicated by the calculated area under curves (AUC) for the amounts of drugs released from different formulations.

In Vivo performance of ophthalmic preparations of betamethasone and phenylephrine hydrochloride in the rabbit eye: Effect of polyvinyl alcohol.

The effect of different concentrations of polyvinyl alcohol 14000 and 72000 (PVA 14 and 72) on the activity of betamethasone and phenylephrine hydrochloride in the rabbit eye was investigated. The polymer of higher molecular weight exerts a more pronounced effect at relatively lower viscosities. Effects on the intraocular pressure are more responsive to changes in viscosity than those on pupillary response.