Study of the effect of ACYP2 single nucleotide polymorphisms rs843711 and rs843706 in Egyptian patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a multifactorial disease with both genetic and environmental factors contributing to its pathogenesis. ACYP2 is a gene that is related to cell differentiation, apoptosis and prevention of malignant tumors. The ACYP2 gene also affects telomere length. The aim of this study was to evaluate the association between ACYP2 single nucleotide polymorphisms (SNPs) (rs843711), and (rs843706) and incidence of HCC in Egyptian HCC patients. The study included 30 patients with HCC and 30 normal controls. Detection of ACYP2 gene SNPs rs843711, and rs843706 in all study participants was done using real time polymerase chain reaction (RT-PCR). The results showed that all participants including HCC patients and controls carried the heterozygous CA (100%) of the rs843706 SNP (p> 0.05). As for the rs843711, 3.3% of HCC patients had the homozygous TT genotype, 46.7% had the heterozygous CT genotype and 50% had the wild CC genotype, while in the control group, 60% had the heterozygous CT genotype and 40% had the wild CC genotype with no significant difference between both groups (p>0.05). We concluded that there was no association between SNPs ACYP2 rs843706 and rs843711 and occurrence of HCC.

White analytical insight for sensitive fluorescent determination of semaglutide and tirzepatide in pharmaceuticals and biological matrices.

The present study is focused on the sensitive determination of newly FDA-approved glucagon-like-peptide agonists semaglutide (SEM) and tirzepatide (TIR). Direct, selective and label-free spectrofluorometric method was proposed and validated (according to ICH guidelines) for determination SEM and TIR in their pure form, newly approved pharmaceuticals and spiked human plasma. The developed method was based on measuring the native fluorescence of SEM and TIR in ethanol at 294.8 and 303 nm after being excited at 216 and 225 nm for SEM and TIR in order. The method sensibility allowed the quantification of both drugs in nano-scale up to 10 ng/mL. Several experimental variables including solvent type, surfactant, and pH were optimized after several attempts to get the best sensitivity for both drugs. The mean recovery percentage of SEM was compared and found in agreement with the reported method using student's t-test and the variance ratio F-test. Additionally, the greenness and whiteness profiles for this approach were evaluated using the GAPI, AGREE, and RGB algorithm; the positive results supported its use as great candidates for successful implementation in quality control labs and the pharmaceutical analysis companies.

A comparison of presentations and outcomes of salvage versus non-salvage abdominal free flap breast reconstructions-Results of a 15-year tertiary referral centre review.

INTRODUCTION: Salvage breast reconstruction with autologous tissue is becoming more prevalent due to a resurgence in implant-based procedures. The latter has caused a commensurate rise in failed or treatment-resistant prosthetic cases requiring conversion to free tissue transfers. Salvage reconstruction is often considered more challenging, owing to patient presentation, prior treatments and intraoperative difficulties. The aim of the study was to test this hypothesis by comparing outcomes of salvage versus non-salvage autologous microsurgical breast reconstructions in a retrospective matched cohort study. METHODS: The demographics, risk factors, operative details and outcomes of patients who underwent free flap salvage of implant-based reconstructions by a single operator (2005-2019) were retrospectively evaluated. For each salvage reconstruction, the consecutive non-salvage abdominal free flap reconstruction was selected for comparison. The clinical outcomes including intraoperative blood loss, operative time, flap survival and complication rates were compared. RESULTS: Of 442 microsurgical patients, 35 (8.0%) had salvage reconstruction comprising 41 flap transfers (29 unilateral, 6 bilateral) and 42 flaps (28 unilateral, 7 bilateral) in nonsalvage reconstruction. Deep inferior epigastric perforator (DIEP) flaps comprised the commonest autologous tissue used in both groups at 74% and 71% respectively. Most patients (83%) underwent salvage reconstruction for severe capsular contractures. There was a significant difference in radiation exposure between groups (salvage reconstruction 89%, non-salvage reconstruction 26%; p<0.00001). All 83 flaps were successful with similar reoperation rates and intraoperative blood losses. Unilateral salvage reconstruction took on average two hours longer than non-salvage reconstruction (p = 0.008). Overall complication rates were similar (p>0.05). CONCLUSION: This 15-year study shows that despite salvage autologous free flap breast reconstruction requiring longer operation times, its intra and postoperative outcomes are generally comparable to non-salvage cases. Therefore, salvage breast reconstruction with free flaps provides a reliable option for failed or suboptimal implant-based reconstructions.

Epidemiology of Migraines in Iraqi Females: Emphasis on Dietary Influence.

Introduction  Migraine is a neurological condition that frequently results in a severe headache. The headache comes in episodes and is occasionally accompanied by nausea, vomiting, and sensitivity to light. Migraines can be caused by a variety of conditions and can last anywhere from three to four hours to several days, with females experiencing them three times more frequently than men. Studies have found some evidence that lifestyle variables, such as nutrition, may play an important role in the emergence of migraines. The purpose of this research is to determine the epidemiology of migraine among females with an emphasis on the relationship between headaches and the dietary habits of females who are enduring migraine attacks in Iraq. Methods This study is descriptive research employing a quantitative method, specifically a survey. The data collection process involved a three-section online survey disseminated to females through internet platforms, including WhatsApp, Viber, Facebook, and Instagram. In this research, 360 females from Sulaymaniyah, Iraq, aged 18 to 35, participated. The survey's primary questions centered on the characteristics of the female respondents, drawing from the International Headache Society (IHS) criteria for migraine diagnosis. Participants meeting the migraine diagnostic criteria were also asked a few questions about aura symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was incorporated, accompanied by inquiries about headache treatment, headache-related signs and symptoms, headache triggers, factors that relieve headaches, sleep routines, dietary consumption, and the impact of each factor on migraines. Results Of the 360 females who participated in the study, 159 (44.2%) experienced migraines, while 201 (55.8%) did not. The dietary habits of females who experienced migraines showed a statistically significant relationship to the duration of their headaches, specifically those lasting from 4 to 72 hours. This relationship was particularly evident in relation to nuts (p-value= 0.000), hot/spicy foods (p-value= 0.000), tomatoes (p-value= 0.005), bananas (p-value=0.01), aspartame (p-value=0.012), beverages containing caffeine (p-value=0.000), and citrusy fruits (p-value=0.008). These findings are based on p-values less than the commonly accepted alpha of 0.05. To maintain good health, it's essential to adhere to healthy eating habits and proper nutritional guidelines. Further research is necessary to identify additional dietary triggers for migraines. Enhancing data collection methods, such as using face-to-face interviews, could improve the quality of future research. Conclusion This study determined the prevalence of migraines among a sample of females in Sulaymaniyah, Iraq, and identified various foods consumed in excess by females without considering their potential impact on migraines.

Heightened vigilance and perceived discrimination in dental trainees' readiness for clinical practice.

PURPOSE/OBJECTIVE: The aims of this study were to examine associations between heightened vigilance and perceived discrimination on readiness for clinical practice and to examine the mediating effects of social support and resilience. METHODS: A survey was distributed to dental trainees (dental and dental hygiene students) enrolled at a US dental school located in the mid-Atlantic region. The survey assessed readiness for clinical practice and included measures of perceived discrimination, heightened vigilance, and the following wellness measures: perceived stress, resilience, anxiety, social support, and coping. Adjusted for gender, and race/ethnicity, we regressed heightened vigilance and perceived discrimination independently on students' readiness for clinical practice. To assess mediation, we computed the direct effects of heightened vigilance and perceived discrimination and potential indirect effects mediated through social support and resilience. RESULTS: A total of 250 students who completed the survey had complete data on all variables. Five percent identified as Black or African Americans, 34% as Asians, and 8% as Hispanic/Latino. Sixty-two percent were female and 91% were dental students. The overall mean (SD) heightened vigilance and perceived discrimination scores were 18.9 (4.9) and 10.5 (7.6), respectively. Only the mean score for heightened vigilance differed significantly by race/ethnicity (p = 0.02). Higher heightened vigilance (odds ratio [OR] = 0.75 95% confidence interval [CI]: 0.25, 2.23), and perceived discrimination (OR = 0.52, 95% CI: 0.33, 0.88) scores were independently associated with lower adjusted odds of reporting high confidence in readiness for clinical practice even after adjusting for the mediating effects of social support and resilience, although the association for heightened vigilance was not statistically significant. CONCLUSIONS: Heightened vigilance and perceived discrimination appear to negatively impact dental trainees' career readiness. Intentional efforts to prioritize an anti-racism approach within dental education programs and patient care across the nation are warranted.

Teledentistry Acceptability Among Latina/o/x Adults in Rural Southwest Virginia.

Inequitable access to dental care remains a barrier to optimal health for rural populations. With the COVID-19 pandemic, teledentistry to improve the delivery of oral health care has been emphasized. Few previous investigations of teledentistry acceptability have included Latina/o/x populations in rural areas of the United States. We recruited Latina/o/x adults (N=91) in rural southwest Virginia to participate in a survey to assess correlates related to teledentistry acceptability. More than half of participants (57%) reported no interest in using teledentistry if it were available. Having a yearly household income above $24,000 and not having dental insurance were positively associated with telehealth acceptability (p=.04 and p=.01, respectively). Inequitable access to dental care may persist even with broad availability of teledentistry services unless there is explicit integration of health equity.

Training for the future: Introducing foundational skills necessary to promote patient-centered care practice in medical physics graduate programs.

Current medical physics graduate training in the United States seldom explicitly includes education on foundational skills necessary to produce Patient-Centered Care (PCC)-focused healthcare providers. Such abilities include effective communication, critical reflection, and ethical decision-making. In this article, we present examples of curricula used to purposefully introduce these skills into graduate training to fill this gap. Presented didactic activities include an introduction to patient communication, ethics in medical physics, and a primer in health disparities for medical physicists. Although development of new curricula is resource-intensive when left to individual programs, we here propose resource-sharing and interprofessional collaboration to overcome these barriers.

Religiosity and COVID-19: Impact on Use of Remote Worship and Changes in Self-Reported Social Support.

Objective: This study examines associations between changes in the use of remote worship services and changes in the types of social support among religious adults during the COVID-19 pandemic. Materials and Methods: Cross-sectional, web survey data (n = 461; 15 May to 6 July 2020) were collected during the COVID-19 pandemic. Multinomial logistic regression models calculated unadjusted odds of increases and decreases of three types of perceived social support from before to during COVID-19 based on remote worship use. Results: Adults who initiated use of remote worship had lower odds of gaining social support for personal problems (OR: 0.38; 95% CI: 0.19, 0.79) and greater odds of reporting less ease of getting practical help from neighbors (OR: 1.77; 95% CI: 1.04, 3.02) compared to adults who never used or stopped using remote worship. Adults who continued using remote worship services were more likely to report less ease of getting practical help from their neighbors (OR: 2.23; 95% CI: 1.17, 4.25) and decreased interest and concern felt from other people (OR: 2.62; 95% CI: 1.24, 5.51) than adults who never used or stopped using remote worship. Conclusions: Adults who initiated and continued using remote worship during the COVID-19 pandemic had poorer perceived social support outcomes relative to adults who never used or stopped using remote services. Despite continued engagement with their religious communities, adults participating in worship remotely may have had residual personal, emotional, and instrumental social support needs that remote worship did not mitigate.

Clinical application and outcomes of reconstructive microsurgery in Africa: A systematic review and meta-analysis.

BACKGROUND: Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa. METHODS: Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates. RESULTS: Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84). CONCLUSION: This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care. REVIEW REGISTRATION: Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.

Taguchi Approach for Optimization of a Green Quantitative 1H-NMR Practice for Characterization of Levetiracetam and Brivaracetam in Pharmaceuticals.

BACKGROUND: Recently, quantitative nuclear magnetic resonance (qNMR) competes with separation techniques such as high performance liquid chromatography (HPLC) and capillary electrophoresis for quantification purposes when dealing with molecules that lack a chromophore. OBJECTIVE: The advantages of the proton nuclear magnetic resonance spectroscopy as a revolutionary quantitative analysis method were exploited aimed at simple and green assessment of two racetams, namely levetiracetam (LEV) and brivaracetam (BRV), as a new family of antiepileptic medications with a unique mechanism of action. The developed technique was effectively used to determine LEV in Keppra tablets and BRV in laboratory-prepared tablets without interfering with the ordinarily suspected excipients. METHOD: A Taguchi approach was applied as a powerful and user-friendly statistical technique for optimization of the qH1NMR experimental design for both drugs. The optimum acquisition conditions were number of scans 32, pulse angle 20°, and relaxation delay of 40 s for LEV and number of scans 128, pulse angle 90°, and relaxation delay of 1 s for BRV. NMR spectra were obtained by means of phloroglucinol as an internal standard and dimethyl sulfoxide-d6 as a solvent. RESULTS: The diagnostic doublet of doublet quantitative signals at 4.3 and at 4.2 ppm were chosen to estimate LEV and BRV, respectively. The recovery of both drugs was quantified through the range of 0.1-12 mg/mL. The limits of detection were 0.013, 0.0013 and the limits of quantitation were 0.04, 0.0039 mg/mL for LEV and BRV correspondingly. CONCLUSIONS: The suggested technique was fully validated according to ICH guidelines and proved to be an eco-friendly practice by means of three different assessment tools, including the green analytical procedures index, national environmental methods index, and analytical eco-scale. qH1NMR should be considered a green alternative for quantification and quality control assessment of pharmaceuticals. HIGHLIGHTS: This research represents the first simple, quick, and green alternative method for determination of both racetams in their pharmaceuticals.

Association between periodontal disease and oral cancer screening among US adults: NHANES 2011-2014.

OBJECTIVES: To examine oral cancer screening rates and associated factors among adults with periodontal disease (PD). We hypothesized that adults with severe PD will be less likely to report receipt of any type of oral cancer screening than adults with no PD. MATERIALS AND METHODS: We used 2011-2014 National Health and Nutrition Examination Survey (NHANES) data on adults ≥30 years. PD status was classified as no PD, mild/moderate PD and severe PD. Survey-adjusted logistic regression analysis was used to examine the model adjusted risk ratio (RR) and 95% confidence intervals (CI) for the outcome of not receiving intraoral, extraoral or both types of oral cancer screenings among adults with PD. Control variables included age, sex, race/ethnicity, health insurance, education, income level, smoking status, alcohol use and last dental visit. RESULTS: The analytic sample included 6962 adults weighted to the national population of adults who had a periodontal examination during 2011-2014. Overall, 31.5%, 26.8% and 20.9% of adults reported receipt of intraoral, extraoral and both types of oral cancer screening, respectively. Almost 40% of adults had some form of PD (7.6% severe and 32.4% mild/moderate PD). A higher proportion of 45-64-year-olds, males, non-Hispanic Blacks, those with less than high school education, with income level less than 200% federal poverty level, or those with no insurance had severe PD than no PD. In adjusted analyses, adults with severe PD were significantly more likely to report no receipt of intraoral (RR = 1.25, 95% CI = 1.12-1.40), extraoral (RR = 1.17, 95% CI = 1.07-1.27) or both types of oral cancer screenings (RR = 1.18, 95% CI = 1.10-1.27) than those with no PD. CONCLUSIONS: Significantly low proportion of adult's age ≥30 years with severe PD reported receiving any type of oral cancer screening. The association between PD and risk of oral cancers points to the need to improve oral cancer screening rates among adults with PD.

SARS-CoV-2 Vaccine Hesitancy in a Sample of US Adults: Role of Perceived Satisfaction With Health, Access to Healthcare, and Attention to COVID-19 News.

Understanding which communities are most likely to be vaccine hesitant is necessary to increase vaccination rates to control the spread of SARS-CoV-2. This cross-sectional survey of adults (n = 501) from three cities in the United States (Miami, FL, New York City, NY, San Francisco, CA) assessed the role of satisfaction with health and healthcare access and consumption of COVID-19 news, previously un-studied variables related to vaccine hesitancy. Multilevel logistic regression tested the relationship between vaccine hesitancy and study variables. Thirteen percent indicated they would not get vaccinated. Black race (OR 2.6; 95% CI: 1.38-5.3), income (OR = 0.64; 95% CI: 0.50-0.83), inattention to COVID-19 news (OR = 1.6; 95% CI: 1.1-2.5), satisfaction with health (OR 0.72; 95% CI: 0.52-0.99), and healthcare access (OR = 1.7; 95% CI: 1.2-2.7) were associated with vaccine hesitancy. Public health officials should consider these variables when designing public health communication about the vaccine to ensure better uptake.

A descriptive pilot study of the immediate impacts of COVID-19 on dental and dental hygiene students' readiness and wellness.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has impacted dental students training across the U.S. academic dental institutions by moving classroom instruction to an online modality, limiting patient care, canceling external rotations, and rescheduling of licensure examinations. OBJECTIVE: The aim of this study was to assess the immediate impacts of COVID-19 on students' readiness to enter clinical practice or residency and its association with well-being (anxiety, perceived stress, coping and social support, and resilience). METHODS: An online REDCap survey was distributed to 407 D1-D4 year dental students and 29 DH3-DH4 year dental hygiene students enrolled at a U.S. dental school. The survey consisted of readiness and wellness measures as well as socio-demographic variables. RESULTS: Overall response rate was 58% (N = 252) ranging from 40% among D4 students to 72% among D1 students. About half (55%) of the respondents were White, a third (34%) Asians and 5% were African Americans. Ninety-two percent were non-Hispanics while 62% were female. Overall mean (SD) anxiety score was 6.5 (5.3) and 26% of respondents reported moderate or severe levels of anxiety. Anxiety score differed significantly by gender with females reporting higher anxiety levels, mean (SD) = 7.3 (5.5) versus 5.2 (4.7) for males; P = 0.002). Furthermore, mean anxiety score differed significantly among the dental school classes, ranging from 5.5 (5.3) among D2 students to 11.8 (6.2) in DH4 students (P = 0.02). CONCLUSION: Academic dental institutions need to be responsive to the heightened anxiety and uncertainly levels of students and provide responsive training and support to mitigate its effects.

Implications of abnormal abdominal wall computed tomographic angiography findings on postmastectomy free flap breast reconstruction.

BACKGROUND: Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. METHODS: We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. RESULTS: Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were "miscellaneous." In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. CONCLUSIONS: CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

Multiobjective optimization of microemulsion- thin layer chromatography with image processing as analytical platform for determination of drugs in plasma using desirability functions.

A new platform was developed for determination of drugs in plasma without extraction or instrumental analysis just using TLC, smart phone digital camera and free image processing software. Lamotrigine, antiepileptic drug was used as model analyte. The proposed platform depends on using oil-in-water (O/W) microemulsion to isolate the drug from plasma proteins and using water-in-oil (W/O) microemulsion as mobile phase for TLC which results in complete separation between lamotrigine and plasma as viewed under UV lamp. The composition of both microemulsions was optimized using Taguchi orthogonal array and Plackett- Burman design. The optimal (O/W) microemulsion predicted composition was 0.01 mL Butyl acetate, 4 mL butanol, 0.925 gm SDS and 8.6 mL water while the (W/O) mobile phase microemulsion was 9 mL Butyl acetate, 1 mL butanol, 0.25 gm SDS, 0.25 mL water. Separation was carried out on a silica gel 60F-254 plate eluted with the (W/O) microemulsion in about 30 min development time. The images of TLC plates were processed using 4 different programs, by comparing their results it was found that "integrated density" measured by Fiji software was the most accurate response that could measure the concentration of lamotrigine in spiked plasma in the range of (20-200) ng/spot. This method was applied also for determination of lamotrigine in lamictal® tablet dosage form using the same mobile phase. The precision of the method was satisfactory; the maximum value of relative standard deviations did not exceed 1.5%. While the accuracy was proved by the low values of % error and high values of recovery.

Lifestyle risk factor related disparities in oral cancer examination in the U.S: a population-based cross-sectional study.

BACKGROUND: Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination. METHODS: Adult participants ≥30 years (n = 9374) of the 2013-2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression estimated odds ratios (OR) and 95% confidence intervals (CIs) of ever and past year oral cancer examination adjusted for age, gender, race/ethnicity, education, income, and time since last dental visit. RESULTS: One third (33%) reported ever been examined for oral cancer, 66% of whom reported an examination in the past year. Adjusted OR (95% CI) of past year examination comparing current and former smokers to non-smokers were 0.51 (0.29, 0.88) and 0.74 (0.53, 1.04) respectively. Similarly, current and former alcohol drinkers relative to abstainers were less likely to report a past year oral cancer examination, OR (95% CI) = 0.84 (0.53, 1.30) and 0.50 (0.30, 0.83) respectively. CONCLUSION: This study showed that smokers and alcohol users were less likely than abstainers to self-report a past year oral cancer examination. Access to affordable and targeted oral cancer examination within the dental care setting might ensure that these high-risk individuals get timely examinations and earlier diagnosis that might improve prognosis and survival.

Implications of abnormal abdominal wall computed tomographic angiography findings on postmastectomy free flap breast reconstruction

Background@#Preoperative computed tomography angiography (CTA) of the abdominal wall vessels is used when planning free flap breast reconstruction (FFBR) because it provides a surgical road map which facilitates flap harvest. However, there are few reports on the effect of abnormal findings on the operative plan. @*Methods@#We conducted a retrospective study of all FFBRs performed at a tertiary referral center over a 6-year period (November 2011 to June 2017). One consultant radiologist reported on the findings. Details on patient demographics, CTA reports, and intraoperative details were collected. @*Results@#Two hundred patients received preoperative CTAs. Fourteen percent of patients (n=28) had abnormal findings. Of these findings, 18% were vascular anomalies; 36% tumorrelated and 46% were “miscellaneous.” In four patients, findings subsequently prevented surgery; they comprised a mesenteric artery aneurysm, absent deep inferior epigastric (DIE) vessels, bilateral occluded DIE arteries, and significant bone metastases. Another patient had no suitable vessels for a free flap and the surgical plan converted to a pedicled transverse rectus abdominis musculocutaneous flap. The remaining incidental findings had no impact on the surgical plan or appropriateness of FFBR. More than one in 10 of those with abnormal findings went on to have further imaging before their operation. @*Conclusions@#CTA in FFBR can have a wider impact than facilitating surgical planning and reducing operative times. Incidental findings can influence the surgical plan, and in some instances, avoid doomed-to-fail and unsafe surgery. It is therefore important that these scans are reported by an experienced radiologist.

Impact of Genotype of Beta Globin Gene on Hepatic and Myocardial Iron Content in Egyptian Patients with Beta Thalassemia.

Iron overload causes most of the mortality and morbidity associated with thalassemia. Excess iron deposits primarily in the liver, but once a threshold level is reached, iron loading may occur in other tissues such as the heart. Magnetic resonance imaging is a well established technique to noninvasively quantify myocardial and liver iron content. More than 300 disease-causing mutations have been identified. We aimed to determine the impact of genotype on liver iron content in patients with beta thalassemia. Cross sectional study was carried on 73 patients with beta thalassemia. MRI liver and heart was performed to determine hepatic and myocardial iron overload. Genotyping was determined by DNA sequencing technique. The mean liver iron content was 17.4 mg/g dw and mean cardiac T2* was 25.5 ms in our patients. Patients with ß0ß0 were associated with significantly higher liver and myocardial iron content compared to those with ß0ß+ and ß+ß+ genotypes. There was a clear association between genotype and both hepatic and myocardial iron overload. Patients with ß0ß0 had significantly higher liver and heart iron content compared to those with ß0ß+ and ß+ß+ genotypes. Liver iron content was strongly correlated to serum ferritin levels and myocardial iron overload.

The Role of CT Angiography in Assessing Deep Inferior Epigastric Perforator Flap Patency in Patients With Pre-existing Abdominal Scars.

BACKGROUND: Abdominal scars can affect the patency of deep inferior epigastric artery (DIEA) perforators and are a concern when planning free flap breast reconstruction (FFBR). Computed tomography angiography (CTA) is routinely used for preoperative DIEA flap imaging. We investigated CTA utility in predicting the most clinically useful DIEA perforators in scarred abdomens. METHODS: A single surgeon's CTA FFBR patients were studied. All were imaged by one radiologist. CTA reports, abdominal scars, and flap intraoperative details were analyzed. The operative findings were then correlated with the CTA "predictions." RESULTS: A hundred and six patients with preoperative CTAs underwent 132 FFBRs, 44% (58) from scarred and 56% (74) from virgin abdomens. All flap transfers were successful. Concordance between perforators identified by CTA preoperatively and those selected by the surgeon intraoperatively was 95% (scarred 93%; non-scarred 96%, P = 0.470). There was a significant difference in the proportion of single-perforator flaps between the two groups (scarred 46%; non-scarred 28%, P = 0.041). "Scarred" flaps were heavier (789 vs 676 g, P = 0.0244) than those harvested from virgin abdomens. CONCLUSIONS: CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. "Scarred" flaps are more likely to be heavier and based on one perforator suggesting that scarring may have an effect on intraflap vascular anatomy. Further investigations are needed to delineate the mechanism by which this occurs.

A comprehensive review of electrocoagulation for water treatment: Potentials and challenges.

Electrocoagulation is an effective electrochemical approach for the treatment of different types of contaminated water and has received considerable attention in recent years due its high efficiency in dealing with numerous stubborn pollutants. It has been successful in dealing with organic and inorganic contaminants with negligible or almost no generation of by-product wastes. During the past decade, vast amount of research has been devoted to utilizing electrocoagulation for the treatment of several types of wastewater, ranging from polluted groundwater to highly contaminated refinery wastewater. This paper offers a comprehensive review of recent literature that has been dedicated to utilizing electrocoagulation for water treatment, focusing on current successes on specific applications in water and wastewater treatment, as well as potentials for future applications. The paper examines such aspects as theory, potential applications, current challenges, recent developments as well as economical concerns associated with the technology. Most of the recent EC research has been focusing on pollutant-specific evaluation without paying attention to cell design, process modeling or industrial applications. This review attempts to highlight the main achievements in the area and outlines the major shortcomings with recommendations for promising research options that can enhance the technology and broaden its range of applications.