Azygos vein preservation revisited: impact on early outcomes after repair of esophageal atresia/tracheoesophageal fistula in newborns.

Since the first successful repair of esophageal atresia/tracheoesophageal fistula (EA-TEF) was performed approximately 8 decades ago, surgeons have made considerable technical advances in solving intraoperative surgical challenges and reducing postoperative complications. According to some surgeons, preserving the Azygos vein makes this modification attractive. This study aimed to evaluate the benefits of preserving the Azygos vein during surgery for esophageal atresia with tracheoesophageal fistula and to highlight its advantages in reducing anastomotic leak, stricture, and other postoperative outcomes. This prospective comparative series was conducted between April 2020 and April 2023. The study included all newborns with EA-TEF eligible for primary repair. Patients were randomized to either Group A or B. Group A underwent Azygos vein preservation, whereas the remaining patients (Group B) underwent Azygos vein disconnection. Sixty-four patients were included in this study. Thirty-two patients (Group A) underwent Azygos vein preservation during EA-TEF repair, and the remaining thirty-two patients (Group B) underwent Azygos vein ligation and disconnection. Both groups were comparable in terms of demographics, clinical data, and operative findings (P > 0.05). Pneumonitis occurred in 4 patients in Group A and 16 patients in Group B. Anastomotic leaks occurred in two (6.2%) patients in Group A and six (18.7%) patients in Group B. There were two deaths in Group A and six deaths in Group B, with a significant difference between the two groups (P = 0.0485). Preserving the Azygos vein during esophageal atresia repair reduces the occurrence of postoperative pneumonia, leakage, and stenosis, and decreases postoperative mortality. Therefore, we declare that this modification is a significant and valuable addition to the current surgical procedures.

A Novel Approach of Periodontal Osseous Wall Piezosplitting and Sequential Bone Expansion in Management of Localized Intra-Bony Defects with Wide Angulation-A Randomized Controlled Trial.

Piezoelectric surgical instruments with various mini-sized tips and cutting technology offer a precise and thin cutting line that could allow the wider use of periodontal osseous wall swaging. This randomized controlled trial was designed to investigate the use of a minimally invasive piezo knife to harvest vascularized interseptal bone pedicles in treating intra-bony defects. Sixteen non-smoking patients (mean age 39.6 ± 3.9) with severe chronic periodontitis were randomly assigned into one of two groups (N = 8). The Group 1 (control) patients were treated by bone substitute grafting of the intra-bony defect, whereas the Group 2 patients were treated by intra-bony defect osseous wall swaging (OWS) combined with xenograft filling of the space created by bone tilting. In both groups, the root surfaces were treated with a neutral 24% EDTA gel followed by saline irrigation. Clinical and radiographic measurements were obtained at baseline and 6 months after surgery. The sites treated with osseous wall swaging showed a statistically significant probing-depth reduction and increase in clinical attachment compared with those of the Group 1 patients. The defect base level was significantly reduced for the OWS group compared to that of the Group 1 control. By contrast, the crestal bone level was significantly higher in the OWS group compared to Group 1. The crestal interseptal bone width was significantly higher in Group 2 at 6 months compared to the baseline value and to that of Group 1 (<0.001). The osseous wall swaging effectively improved the clinical hard- and soft-tissue parameters. The use of mini inserts piezo-cutting, sequential bone expanders for osseous wall redirection, and root surface EDTA etching appears to be a reliable approach that could allow the use of OWS at any interproximal dimension.

A modified weighted chimp optimization algorithm for training feed-forward neural network.

Swarm intelligence algorithms (SI) have an excellent ability to search for the optimal solution and they are applying two mechanisms during the search. The first mechanism is exploration, to explore a vast area in the search space, and when they found a promising area they switch from the exploration to the exploitation mechanism. A good SI algorithm can balance the exploration and the exploitation mechanism. In this paper, we propose a modified version of the chimp optimization algorithm (ChOA) to train a feed-forward neural network (FNN). The proposed algorithm is called a modified weighted chimp optimization algorithm (MWChOA). The main drawback of the standard ChOA and the weighted chimp optimization algorithm (WChOA) is they can be trapped in local optima because most of the solutions update their positions based on the position of the four leader solutions in the population. In the proposed algorithm, we reduced the number of leader solutions from four to three, and we found that reducing the number of leader solutions enhances the search and increases the exploration phase in the proposed algorithm, and avoids trapping in local optima. We test the proposed algorithm on the Eleven dataset and compare it against 16 SI algorithms. The results show that the proposed algorithm can achieve success to train the FNN when compare to the other SI algorithms.

Lesion depth and marrow stimulation results.

AIM: The aim of this study was to study the importance Osteochondral lesion (OCL) depth as a singular factor for treatment outcomes using marrow stimulation. We hypothesized that the clinical outcomes of marrow stimulation would be inferior for lesions with depths of more than 5 mm compared to those less than 5 mm. MATERIALS & METHODS: An interventional prospective cohort study was conducted on 55 ankles in 55 patients who had been diagnosed with full-thickness osteochondral lesions of the talus; stage II, III, IV according to Anderson staging system based on magnetic resonance imaging; depth of 10 mm or less; and area of 150 mm2 or less measured by preoperative computed tomography. According to lesion depth, patients were divided into two groups: group (A) ≤ 5 mm, and group (B) ˃ 5 mm. The mean follow-up period for both groups was 30 months (range, 22-40). RESULTS: For groups A and B the average preoperative Foot and Ankle Outcome Scores (FAOS) were 43.1 ± 8.8 (range, 25-52) and 46 ± 8.5 (range, 32-60), respectively, and improved to 90 ± 4.3 (range, 80-96) (P = 0.001) and 75 ± 6.4 (range, 65-88) (P = 0.001) at the final follow-up. The average time to full weight bearing was 12 weeks (range, 10-16) in group A and 16 weeks (range, 12-20) in group B. CONCLUSIONS: Although treatment of OCLs is still undergoing changes and there are many prognostic factors that affect outcomes during marrow stimulation treatment, depth of OCL was shown to be an independent factor affecting outcomes. OCLs of less than 5 mm in depth were more likely to have superior clinical outcomes compared to OCLs of more than 5 mm. CLINICAL SIGNIFICANCE: The depth of OCL talus is an important factor as it affects the outcome of arthroscopic marrow stimulation inversely. LEVEL OF EVIDENCE: I.

Evaluation of Double-Faced Tubularized Preputial Flap versus Duckett's Procedure for Repair of Penoscrotal Hypospadias with Significant Penile Curvature: A Comparative Study.

Background: Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett's procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett's procedure. Results: No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett's repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions: The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.

Sexual Dysfunction Among Egyptian Idiopathic Parkinson's Disease Patients.

BACKGROUND: One of the non-motor features of idiopathic Parkinson's disease (IPD) is sexual dysfunction (SD) which is under-recognized and, consequently, undertreated. This study aimed to evaluate SD in patients with IPD. PATIENTS AND METHODS: The study was conducted on 67 IPD patients; 30 healthy subjects with age and gender matching with the patients served as the control group. All participants were subjected to sexual function assessment using the Arabic version of Arizona Sexual Experience Scale (ASEX), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI), while the severity of IPD was assessed using the modified Hoehn and Yahr scoring scale and MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS: There were no statistically significant differences between patients with IPD and the control group regarding MMSE, hypertension, diabetes mellitus, or dyslipidemia. However, BDI scores were significantly higher in patients with IPD. The rate of SD among our patients was 64% compared to 30% in the control group. The total score and subscales of ASEX were significantly higher in IPD patients than in controls. SD showed a significant correlation with the severity of the IPD irrespective of other variables, including patient age, sex, disease duration, hypertension, diabetes, dyslipidemia, smoking, and dose of L-dopa. CONCLUSION: SD is a commonly underrated feature in patients with IPD; it should be investigated carefully as it is an important non-motor symptom that correlates with disease severity.

Preoperative Diagnosis Failure for a Rare Gastric Collision Tumor: A Case Report.

Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors of the gastrointestinal tract (GIT), usually occur as a solitary neoplasm. Inflammatory florid polyp (IFP) is a solitary rare benign lesion of the gastrointestinal tract, mainly occur in the gastric antrum, whose atypical presentation can mimic GISTs or other malignant tumors, therefore the synchronous occurrence of GISTs and IFP is extremely rare. We had a case of a 58-year-old man that was presented with recurrent epigastric pain and recurrent melena. Upper endoscopic examination revealed a large polypoid antrum polyp measured 7 cm at greatest dimension with focal ulceration. Clinical and radiological features did not reach the definite diagnosis until histopathological evaluation with immunohistochemical analysis was performed. Surgical intervention is recommended and partial gastrectomy was done with wide resection margins. Histological examination revealed two distinct GISTs and IFP parts presenting a collision tumor that showed spindle and epitheloid cells consistent with GISTs with histological features of florid polyp showed a characteristic perivascular onion-skin arrangement of spindle cells with dense chronic inflammatory infiltrate including eosinophils and lymphocytes. Immunohistochemical studies have been done and revealed an association between GISTs and IFP. To the best of our knowledge, this is the first case of a collision tumor consisting of a GIST and an IFP arising in the stomach. In conclusion, the gastrointestinal stromal tumor is the comments mesenchymal tumor of GIT and IFP is a rare benign lesion of GIT therefore association between GIST and IFP as a collision tumor is extremely rare.

Hypoxic metabolism in human hematopoietic stem cells.

BACKGROUND: Adult hematopoietic stem cells (HSCs) are maintained in a microenvironment, known as niche in the endosteal regions of the bone marrow. This stem cell niche with low oxygen tension requires HSCs to adopt a unique metabolic profile. We have recently demonstrated that mouse long-term hematopoietic stem cells (LT-HSCs) utilize glycolysis instead of mitochondrial oxidative phosphorylation as their main energy source. However, the metabolic phenotype of human hematopoietic progenitor and stem cells (HPSCs) remains unknown. RESULTS: We show that HPSCs have a similar metabolic phenotype, as shown by high rates of glycolysis, and low rates of oxygen consumption. Fractionation of human mobilized peripheral blood cells based on their metabolic footprint shows that cells with a low mitochondrial potential are highly enriched for HPSCs. Remarkably, low MP cells had much better repopulation ability as compared to high MP cells. Moreover, similar to their murine counterparts, we show that Hif-1α is upregulated in human HPSCs, where it is transcriptionally regulated by Meis1. Finally, we show that Meis1 and its cofactors Pbx1 and HoxA9 play an important role in transcriptional activation of Hif-1α in a cooperative manner. CONCLUSIONS: These findings highlight the unique metabolic properties of human HPSCs and the transcriptional network that regulates their metabolic phenotype.

Ten years experience with a novel modification of plastibell circumcision.

BACKGROUND: Plastibell device is a satisfactory method of circumcision in infants. However the most common post-operative complication was bleeding (especially from the frenulum site). As a result, we introduce a novel modification of the device to prevent this complication. PATIENTS AND METHODS: A prospective comparative study of Plastibell circumcision in infants up to the age of 12 months was conducted, using conventional Plastibell device and modified Plastibell device circumcision. In The first group (1000 infants), circumcision was performed with conventional Plastibell device while in the second group (4500 infants), circumcision was done with modified Plastibell device. RESULTS: The mean age was 8 weeks. The mean operating time were 8.5 min and 5.9 min for conventional Plastibell ring and modified Plastibell device circumcision respectively. The most common postoperative complication in first groups was bleeding. CONCLUSION: This modified Plastibell device, prevents the most series complication of bleeding. It is fast and ensures excellent cosmoses compared with the standard Plastibell template circumcision. Also it is easy to perform and allows the paediatric surgeon to achieve consistently excellent cosmetic results. Moreover, the shorter operating time makes circumcision by the modified Plastibell device a more practical method. The technique will be described in detail.