Tumor microenvironment and immune system preservation in early-stage breast cancer: routes for early recurrence after mastectomy and treatment for lobular and ductal forms of disease.

BACKGROUND: Intra-ductal cancer (IDC) is the most common type of breast cancer, with intra-lobular cancer (ILC) coming in second. Surgery is the primary treatment for early stage breast cancer. There are now irrefutable data demonstrating that the immune context of breast tumors can influence growth and metastasis. Adjuvant chemotherapy may be administered in patients who are at a high risk of recurrence. Our goal was to identify the processes underlying both types of early local recurrences. METHODS: This was a case-control observational study. Within 2 years of receiving adjuvant taxan and anthracycline-based chemotherapy, as well as modified radical mastectomy (MRM), early stage IDC and ILC recurred. Vimentin, α-smooth muscle actin (SMA), platelet-derived growth factor (PDGF), matrix metalloproteinase (MMP1), and clustered differentiation (CD95) were investigated. RESULTS: Of the samples in the ductal type group, 25 showed local recurrence, and 25 did not. Six individuals in the lobular-type group did not experience recurrence, whereas seven did. Vimentin (p = 0.000 and 0.021), PDGF (p = 0.000 and 0.002), and CD95 (p = 0.000 and 0.045) expressions were significantly different in ductal and lobular carcinoma types, respectively. Measurement of ductal type was the sole significant difference found in MMP1 (p = 0.000) and α-SMA (p = 0.000). α-SMA and CD95 were two variables that helped the recurrence mechanism in the ductal type according to the pathway analysis. In contrast, the CD95 route is a recurrent mechanism for the lobular form. CONCLUSIONS: While the immune system plays a larger role in ILC, the tumor microenvironment and immune system both influence the recurrence of IDC. According to this study, improving the immune system may be a viable cancer treatment option.

Predictors of time-to-nadir serum creatinine after drainage of bilaterally obstructed kidneys due to bladder cancer.

Background: There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy (PCN). This study aimed to assess the predictors of the time-to-nadir (TTN) of serum creatinine (SCr) levels after drainage of bilaterally obstructed kidneys (BOKs) due to bladder cancer (BC) by PCN. Materials and methods: This prospective nonrandomized study included patients with BOKs due to BC treated by PCN between April 2019 and March 2022. The primary outcome measure was TTN. Results: Of the 55 patients with a median age (range) of 66 years (47-86 years), 32 (58.2%) had a normal nadir SCr and 23 (41.8%) had a high nadir SCr within 21 days after drainage of BOKs due to BC. High nadir SCr was associated with a higher mean age (p = 0.011) and lower body mass index (BMI, p = 0.043). However, patients with normal nadir SCr had a significantly shorter TTN (p = 0.023) and an increased mean SCr trajectory (p < 0.001) during TTN. In multivariate analysis, low urine output at presentation (p = 0.021) and high BMI (p = 0.006) were associated with longer TTN. However, the mean parenchymal thickness (p = 0.428) and laterality of drainage (p = 0.466) were not associated with the mean TTN and SCr normalization rates. According to the modified Clavien-Dindo classification, 8 cases of hematuria were managed conservatively (grade 2), and 2 cases of PCN slippage were repositioned using local anesthesia (grade 3). Conclusions: Despite the safety of PCN for drainage of BOKs due to BC, more than 41% of the patients failed to have a normal nadir SCr. Predrainage low urine output and high BMI were associated with longer TTN. Laterality of drainage had no significant effects on the TTN and SCr trajectory.

Revitalize splenic functions. Following a splenectomy for trauma, a small amount of splenic autotransplantation was performed.

INTRODUCTION: The spleen is a responsible significant part of the immune system; after Splenectomy following trauma, the immune system changes; splenic autotransplantation can preserve the immune system after trauma and Splenectomy. BACKGROUND: Patients can be protected from immune dysfunction by autotransplanting splenic tissues after splenectomy following trauma because their immune systems and spleens are changed. Patients can gain their immune function after splenic autotransplantation. METHODS: Patient classification methods are into three categories, Group A, 6 cases with auto-translation; Group B, 6 cases without transplantation; Group C, seven regular people serving as the control. AIM OF WORK: The aim of the work is not to compare outcome methods or compare types of autotransplantation; This work aims to document postoperative radiological, immunological, clinical, and hematological investigations. We concentrated on the results of investigations more than the types of operation or approach or types of autotransplantation. RESULTS: We showed that, after comparing each group with normal individuals subjects, patients who did not undergo autotransplantation had significantly higher platelet counts, a more significant percentage of micronucleated reticulocytes, increased levels of naive B lymphocytes, changes in class-switched memory and class-unswitched memory B cells, and higher levels of PD1 on CD8 + T lymphocytes. Nevertheless, neither splenic autotransplant patients nor the average general population showed any appreciable variations in any of the parameters. CONCLUSIONS: Spleen's activities with adequate hemocatheter activity and recovery of the immunological deficit after splenic autotransplantation.

Isolated ventral congenital penile curvature treated by incisionless plication of tunica albuginea in adults: A prospective case series.

Background: Numerous surgical techniques are available for the correction of isolated ventral congenital penile curvature (IVCPC). This study aimed to assess the outcomes and predictors of IVCPC treatment in adults using an incisionless plication technique. Materials and methods: This prospective case series examined patients with IVCPC who were treated in our hospital between October 2017 and February 2020 using incisionless plication of the tunica albuginea (Essed-Schroeder technique) with a covering pair of absorbable sutures. The primary outcomes were successful correction (defined as a residual curvature ≤15 degrees) and patient satisfaction. Postoperative follow-ups were performed at 3, 6, and 12 months. Results: A total of 23 patients were treated for IVCPC with a mean (range) age of 25.3 (18-31) years. Eighteen patients (78.3%) were single with cosmetic complaints, whereas the other 5 patients (21.7%) were married and presented with a difficult vaginal intromission. The mean (range) curvature, length, and operative time were 40 (30-50) degrees, 15 (10-19) cm, and 82 (65-100) minutes, respectively. Postoperative penile pain and numbness occurred in 13 patients (56.5 %) and 7 patients (30.4%) only within the first month, respectively. Palpable suture knots were reported in 15 patients (65.5%) without being bothersome up to 12 months. The postoperative means (ranges) of penile curvature and length were significantly different from that of the preoperative values at 3 (5 [0-20] degrees and 14.5 [9-18.5] cm), 6 (5 [0-20] degrees and 14.5 [9-18.5] cm), and 12 months (5 [0-30] degrees and 14.5 [9-18.5] cm; all p < 0.001). Age, preoperative penile curvature, penile length, postoperative pain, wound infections, and knot palpation insignificantly affected curvature recurrence. Seventeen patients (73.9%) were very satisfied with their surgical outcomes. Conclusions: Incisionless plication of the tunica albuginea is effective and safe for the correction of IVCPC in adults with high success and patient satisfaction rates.

Distinguishing features of Lycium L. species (family Solanaceae) distributed in Egypt based on their anatomical, metabolic, molecular, and ecological characteristics.

Among the 70-80 species of the genus Lycium (family Solanaceae) disjunctly distributed around the world, only three are frequently distributed in different locations in Egypt. Due to the morphological similarities between these three species, there is a need for alternative tools to distinguish them. Thus, the objective of this study was to revise the taxonomic features of Lycium europaeum L., Lycium shawii Roem. & Schult., and Lycium schweinfurthii var. aschersonii (Dammer) Feinbrun in consideration of their anatomical, metabolic, molecular, and ecological characteristics. In addition to analysis of their anatomical and ecological features, DNA barcoding was performed for molecular characterization through internal transcribed spacer (ITS) sequencing and start codon targeted (SCoT) markers. Furthermore, metabolic profiling of the studied species was conducted based on gas chromatography-mass spectrometry (GC-MS). The observed anatomical features of the adaxial and abaxial epidermal layers, type of mesophyll, crystals, number of palisade and spongy layers, and the vascular system showed variations between the studied species. Beyond this, the anatomy of the leaves showed an isobilateral structure in the studied species, without distinct differences. Species were molecularly identified in terms of ITS sequences and SCoT markers. The ITS sequences were deposited in GenBank with accession numbers ON149839.1, OP597546.1, and ON521125.1 for L. europaeum L., L. shawii, and L. schweinfurthii var. aschersonii, respectively. The sequences showed variations in GC content between the studied species; this was 63.6% in L. europaeum, 61.53% in L. shawii, and 63.55% in L. schweinfurthii var. aschersonii. A total of 62 amplified fragments, including 44 polymorphic fragments with a ratio of 70.97%, were obtained in the SCoT analysis, as well as unique amplicons in L. europaeum L., shawii, and L. schweinfurthii var. aschersonii of 5, 11, and 4 fragments, respectively. Through GC-MS profiling, 38 compounds were identified with clear fluctuations in the extracts of each species. Of these, 23 were distinguishing chemicals that could help in chemical identification of the extracts of the studied species. The present study succeeds in identifying alternative clear and diverse characteristics that can be used to distinguish between L. europaeum, L. shawii, and L. schweinfurthii var. aschersonii.

Serum creatinine trajectory after drainage of kidneys with bilateral malignant ureteral obstruction: a prospective non-randomized comparative study.

BACKGROUND: Serum creatinine trajectory (SCr-Tr) is a neglected prognostic tool for chronic and acute kidney injury. We aimed to assess the predictors of SCr-Tr during the time-to-nadir and serum creatinine (SCr) normalization rate after drainage, using percutaneous nephrostomy in patients with bilateral malignant ureteral obstruction. METHODS: A prospective non-randomized study was performed on SCr-Tr in patients with bilateral malignant ureteral obstruction from August 2019 to March 2022. The primary outcome was SCr-Tr during the time-to-nadir. RESULTS: This study included 102 patients with a mean age ± SD of 59.6 ± 14.7 years. SCr-Tr was non-linear with a mean ± SD (range) of 0.5 ± 0.4 (0.03-2.3) mg/dl/day. Multivariate analyses revealed that female gender (p = 0.016), body mass index (BMI; p = 0.005), and SCr at presentation (p < 0.001) were predictors of rapid SCr-Tr during the time-to-nadir. However, age (p = 0.008) and low urine output at presentation (p = 0.015) were associated with a lower SCr-Tr. In contrast, laterality of drainage (p = 0.544) and mean parenchymal thickness (p = 0.066) were not associated with mean SCr-Tr. Also, only the mean parenchymal thickness (p = 0.002) was a predictor of rapid SCr-Tr at ≥ 0.5 mg/dl/day. However, low BMI (p = 0.023) was associated with a high SCr normalization rate, while unilateral drainage (p = 0.045) was associated with a lower rate. CONCLUSIONS: Female gender, low BMI, and SCr at presentation were predictors of rapid SCr-Tr during the time-to-nadir. Bilateral drainage was an independent predictor of SCr normalization rate, but not of rapid SCr-Tr. The mean parenchymal thickness was the only independent predictor for rapid SCr-Tr at ≥ 0.5 mg/dl/day.

Physiological and Anatomical Responses of Faba Bean Plants Infected with Chocolate Spot Disease to Chemical Inducers.

Plant diseases are biotic stresses that restrict crop plants' ability to develop and produce. Numerous foliar diseases, such as chocolate spots, can cause significant production losses in Vicia faba plants. Certain chemical inducers, including salicylic acid (SA), oxalic acid (OA), nicotinic acid (NA), and benzoic acid (BA), were used in this study to assess efficacy in controlling these diseases. A foliar spray of these phenolic acids was used to manage the impacts of the biotic stress resulting from disease incidence. All tested chemical inducers resulted in a significant decrease in disease severity. They also enhanced the defense system of treated plants through increasing antioxidant enzyme activity (Peroxidase, polyphenol oxidase, ß-1, 3-glucanase, and chitinase) compared to the corresponding control. Healthy leaves of faba plants recorded the lowest (p < 0.05) values of all antioxidant activities compared to those plants infected by Botrytis fabae. Moreover, the separation of proteins using SDS-PAGE showed slight differences among treatments. Furthermore, foliar spray with natural organic acids reduced the adverse effects of fungal infection by expediting recovery. The SA (5 mM) treatment produced a pronounced increase in the upper, lower epidermis, palisade thickness, spongy tissues, midrib zone, length, and width of vascular bundle. The foliar application with other treatments resulted in a slight increase in the thickness of the examined layers, especially by benzoic acid. In general, all tested chemical inducers could alleviate the adverse effects of the biotic stress on faba bean plants infected by Botrytis fabae.

Characterization of Some Cichorium Taxa Grown under Mediterranean Climate Using Morphological Traits and Molecular Markers.

The verification of taxonomic identities is of the highest significance in the field of biological study and categorization. Morpho-molecular characterization can clarify uncertainties in distinguishing between taxonomic groups. In this study, we characterized five local taxa of the genus Cichorium using morphological and molecular markers for taxonomic authentication and probably future genetic improvement. The five Cichorium taxa grown under the Mediterranean climate using morphological traits and molecular markers showed variations. The examined taxa showed a widespread range of variations in leaf characteristics, i.e., shape, type, texture, margin, and apex and cypsela characteristics i.e., shape, color, and surface pattern. The phylogenetic tree categorized the Cichorium intybus var. intybus and C. intybus var. foliosum in a single group, whereas C. endivia var. endivia was grouped separately. However, C. endivia var. crispum and C. endivia subsp. pumilum were classified as a cluster. The recorded variance between classes using the molecular markers SCoT, ISSR, and RAPD was documented at 34.43%, 36.62%, and 40.34%, respectively. Authentication using molecular tools proved the usefulness of a dichotomous indented key, as revealed by morphological identification. The integrated methodology using morphological and molecular assessment could support improved verification and authentication of the various taxa of chicory. It seems likely that the Egyptian chicory belongs to C. endivia subsp. pumilum.

Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage?

There is a well-known relationship between malignancy and impairment of kidney functions, either in the form of acute kidney injury or chronic kidney disease. In the former, however, bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology. It warrants urgent drainage of the kidneys in emergency settings. However, there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients. This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature. Also, we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy. Despite the frequent trials for improving the success rates and functions of ureteral stents, placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction, especially in patients with advanced malignancy. However, the disturbance of the quality of life of those patients remains a major unresolved concern. Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed, the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors, including increased urine output, serum creatinine trajectory, and time-to-nadir serum creatinine after drainage.

Effects of Plant-Growth-Promoting Rhizobacteria (PGPR) and Cyanobacteria on Botanical Characteristics of Tomato (Solanum lycopersicon L.) Plants.

Tomatoes are an important agricultural product because they contain high concentrations of bioactive substances, such as folate, ascorbate, polyphenols, and carotenoids, as well as many other essential elements. As a result, tomatoes are thought to be extremely beneficial to human health. Chemical fertilizers and insecticides are routinely utilized to maximize tomato production. In this context, microbial inoculations, particularly those containing PGPR, may be utilized in place of chemical fertilizers and pesticides. In this study, we investigated the effects of PGPR (Bacillus subtilis, and Bacillus amyloliquefaciens) and cyanobacteria when utilized alone, and in conjunction with each other, on the growth, quality, and yield of fresh fruits of tomato plants. The results showed that the inoculation significantly increased all measured parameters of tomato plants compared with the control. Combined use of B. subtilis and B. amyloliquefaciens had a positive impact on tomato yield, increasing fruit yield. Moreover, leaflet anatomical characteristics were altered, with increased thickness of the upper epidermis, lower epidermis, palisade tissue, spongy tissue, and vascular bundles. Tomato fruit quality was improved, as measured by an increased number of fruit per plant (76% increase), fruit weight (g; 33% increase), fruit height (cm; 50% increase), fruit diameter (cm; 50%), total soluble solids (TSS; 26% increase), and ascorbic acid (mg/100 g F.W.; 75% increase), relative to the control, in the first season. In addition, fruit chemical contents (N, P, and K) were increased with inoculation. The results suggest that inoculation with B. subtilis and B. amyloliquefaciens could be successfully used to enhance tomato plant growth and yield.

Improving the Tolerance to Salinity Stress in Lettuce Plants (Lactuca sativa L.) Using Exogenous Application of Salicylic Acid, Yeast, and Zeolite.

Salinity is among the most limiting factors of crop production worldwide. This study aims to investigate the influence of the exogenous application of zeolite, yeast, and salicylic acid in alleviating the negative effect of salt stress under field conditions. Lettuce plants (Lactuca sativa L. cv. Batavia) were tested in a split-plot arrangement replicated three times. The salt stress was applied as a whole-plot factor in the concentrations (0 mM, 50 mM, 100 mM, and 150 mM NaCl). After 28 days of sowing, the plants were sprayed twice during the foliage growth with (control, salicylic acid 0.02%, yeast extract 3%, and zeolite 0.5%) as a split-plot factor. The length of roots and shoots, the number and area of leaves, and the biomass accumulation (dry and fresh weights) were measured 50 days after sowing. The concentrations of total soluble sugars, proline, Chlorophylls a and b in leaves have also been quantified. Salt stress significantly reduced the growth and the total chlorophyll of the lettuce plants (p < 0.05) and increased their proline and sugar contents'. Zeolite application improved the growth of lettuce at 0 and 50 mM NaCl, but at the highest salinity level only the number of leaves was improved by 15%. At a mild salinity stress, the application of salicylic acid has significantly (p < 0.05) increased the root length, height of plant, chlorophyll, and proline contents. Regarding the high stress levels (100 and 150 mM NaCl), yeast application showed the best tolerance to salinity stress by improving significantly most of the growth parameters (p < 0.05) but with lower proline, sugar, and chlorophyll contents. In general, foliar spray of yeast extract may offer a good alternative source of nutrients through leaves, leading to a better tolerance of the high salt stress exerted on roots.

Predictors of nadir serum creatinine after drainage of bilaterally obstructed kidneys due to different etiologies.

PURPOSE: To identify the predictors of nadir serum creatinine (SCr) after drainage of bilaterally obstructed kidneys (BOKs) by different modes: double-J stent (JJ) versus percutaneous nephrostomy (PCN) and unilateral versus bilateral drainage. METHODS: A prospective non-randomized study was performed on patients with BOKs and raised SCr during December 2019-November 2021. Relevant variables were studied for improvement and non-improvement and for benign and malignant underlying obstructions (BUO and MUO). RESULTS: This study included 107 patients with BOKs including 68 (63.6%) males and 39 (36.4%) females. After drainage, 86 (80.4%) patients get improved, while 21 (19.6%) patients failed to reach a nadir SCr. Drainage by PCN was significantly higher in MUO, while JJ was significantly higher in BUO (p < 0.001). Also, bilateral drainage was a significant predictor of improvement in MUO (p = 0.03). In contrast, mode of drainage had no significant effect on improvement in BUO (p = 0.84), but bilateral drainage was a significant factor of rapid time to nadir (p = 0.02). Univariate analyses revealed no significant effects on the improvement in SCr from the studied variables, except the male gender (p = 0.01), old age (p < 0.001), MUO (p = 0.01), unilateral drainage (p < 0.001), and use of PCN for drainage (p < 0.001). By multivariate analysis, unilateral drainage (p = 0.01) and MUO (p < 0.001) were independent predictors of non-improvement in patients with BOKs. CONCLUSIONS: Male gender, old age, MUO, unilateral drainage, and drainage by PCN were significant predictors of non-improvement in SCr after drainage of BOKs. However, unilateral drainage and MUO were the only independent predictors of non-improvement.

Sleeve Gastrectomy and Cholecystectomy are Safe in Obese Patients with Asymptomatic Cholelithiasis. A Multicenter Randomized Trial.

BACKGROUND: Obesity is a severe health problem. Gallstones may symptomatize after sleeve gastrectomy (SG). Concomitant laparoscopic cholecystectomy (LC) with SG is controversial. The effects of SG and LC versus delayed LC following SG in obese patients with asymptomatic gallbladder stones were evaluated. METHODS: A randomized trial of 222 morbidly obese patients with gallbladder stones divided them into two equal groups: SG + LC and SG-only. This multicenter study conducted from January 2016 to January 2019. RESULTS: Except for operative time and postoperative hospital stay, there was no statistically significant difference between LSG + LC group and SG group (P < 0.001). In SG + LC group, LC added 40.7 min to SG, three patients (3%) required conversion, early postoperative complications occurred in 9 cases (9/111, 9%), three cases required re-intervention (3%). In SG group, the complicated cases required LC were 61 cases (61/111, 55%). Acute cholecystitis (26/61, 42.7%) was the most common gallstone symptoms. Most complicated cases occurred in the first-year follow-up (52/61, 85%). In the delayed LC group (61 patients), operative time was 50.13 ± 1.99 min, open conversion occurred in 2 cases (2/61, 3.2%), early postoperative complications occurred in four patients (4/61, 6.4%) and postoperative re-intervention were due to bile leaks and cystic artery bleeding (2/61, 3.2%). CONCLUSIONS: SG with LC prolongs the operative time and hospital stay, but the perioperative complications are the same as delayed LC; LC with SG minimizes the need for a second surgery. Concomitant LC with SG is safe.

Prognostic and clinicopathological implications of expression of Beclin-1 and hypoxia-inducible factor 1α in serous ovarian carcinoma: an immunohistochemical study.

Serous ovarian carcinoma (SOC) is an ovarian cancer with a high fatality rate. Therefore, a lot of researchers have tried to identify novel prognostic biomarkers which might improve the patient prognosis. The aims of the study were to detect the tissue protein expression of Beclin-1 in addition to HIF-1α in SOC patients, to evaluate the relationship between their expression, the clinicopathological parameters, patients' prognosis, and the relation to chemotherapy resistance in SOC. We evaluated the expression of Beclin-1 in addition to HIF-1α in 60 patients with SOC using immunohistochemistry, followed all patients for about 36 months, analyzed associations between both markers' expression, clinicopathological data, and patients' prognosis. Beclin-1 expression was related to low grade (p = 0.002), early SOC stage, absence of peritoneal spread (p = 0.006), and absence of lymph nodes, and distant metastases (p = 0.004 and < 0.001 respectively), while HIF-1α expression was associated with higher grade and stage (p = 0.007), and presence of nodal and distant metastases (p < 0.001 and = 0.012 respectively). High Beclin-1 expression and low HIF-1α expression were positively associated with good response to chemotherapy (p = 0.047 and p = 0.022 respectively), a lower recurrence rate after successful therapy (p = 0.006 and < 0.001 respectively), and increased three-year recurrence-free and overall survival rates (p < 0.001). In SOC patients; Beclin-1 is a good prognostic marker, while HIF-1α is a poor prognostic marker.

Effect of Salt Stress and Foliar Application of Salicylic Acid on Morphological, Biochemical, Anatomical, and Productivity Characteristics of Cowpea (Vigna unguiculata L.) Plants.

The present study aimed to investigate the impact of salinity on vegetative growth, chemical constituents, and yields of cowpeas (Vigna unguiculata) and the possible benefits of salicylic acid (SA) on these plants after damage from salinity. To achieve these objectives, two pot experiments were carried out at the Faculty of Agriculture, Al-Azhar University, Egypt, during the two growing seasons of 2019 and 2020. The results revealed that salinity significantly decreased, and SA treatment substantially increased the plant height, number of compound leaves, number of internodes per plant, fresh weights of leaves and stems, productivity, photosynthetic pigments content, and concentrations of nitrogen (N), phosphorus (P), and potassium (K) of the cowpea plants compared with the control. The anatomical structure of stems and leaves of the plants were also investigated, and it was found that positive variations in the anatomical structure of the median portion of the main stems and blades of mature foliage leaves were detected in the stressed and SA-treated plants. In conclusion, SA treatment increased the salt stress tolerance of cowpea plants by improving the morphological and physiological attributes of the plants.

Clinico-pathological and prognostic implications of Srx, Nrf2, and PROX1 expression in gastric cancer and adjacent non-neoplastic mucosa - an immunohistochemical study.

INTRODUCTION: Sulfiredoxin (Srx), which is an endogenous antioxidant substance which could, regulate the signaling pathways of reactive oxygen species. Nuclear factor erythroid 2-related factor 2 (Nrf2) is Cap-N-collar (CNC) transcription factors family member that have essential roles in regulation of antioxidant response. The transcription factor PROX1 is a transcription factor and a key regulatory protein in cancer development. AIM OF THE STUDY: To analyze levels of tissue expression of Srx, Nrf2, and PROX1 in gastric cancer and adjacent non-neoplastic gastric mucosa to clarify the relationship between their expression levels, clinical, pathological parameters and patients' outcome. The results might lead to discovering novel targeted therapies to gastric cancers. MATERIAL AND METHODS: We included 70 paraffin-embedded samples: 50 specimens from gastric carcinomas and 20 specimens from adjacent non-neoplastic gastric mucosa. All samples are stained with Srx, Nrf2, and PROX1 using immunohistochemistry, correlated their expression with clinicopathological and prognostic parameters of patients. RESULTS: High levels of Srx and Nrf2 expression were positively associated with higher cancer grade (p = 0.006, 0.031 respectively), advanced stage (p < 0.001, 0.02 respectively), higher incidence of distant metastases (p = 0.029, 0.03 respectively) and dismal outcome (p < 0.001). High levels of PROX1 expression were associated with lower cancer grade (p = 0.005), absence of lymph nodes metastases (p = 0.023), early stage (p = 0.003), absence of relapse (p = 0.004), and favorable outcome (p < 0.001). CONCLUSIONS: Srx and Nrf2 expression increase gastric cancer invasiveness, suggesting their utility as poor prognostic markers, but PROX1 serves as a favorable prognostic marker of gastric cancer patients.

Health related quality of life after urinary diversion. Which technique is better?

OBJECTIVE: To compare quality of life (QoL) after urinary diversion (UD) following radical cystectomy (RC) using validated questionnaires. PATIENTS AND METHODS: Between January 2011 and June 2016, 150 patients (121 men [80.7%] and 29 women [19.3%]) with invasive bladder cancer who underwent RC and UD were included in this prospective study. Patients were divided into 2 groups; group I included the orthotopic neobladder 50 (33.3%) and uretro-sigmoidostomy 41 (27.3%) and group II included uretero-cutanoustomy 33 (22.1%) and ileal conduit 26 (17.3%) patients. QOL was evaluated using the Functional Assessment of Cancer Therapy-Bladder Cancer. The erectile function (EF) was assessed using the Sexual Health Inventory for Men Questionnaire. Evaluation was done before and after one year postoperatively. RESULTS: The mean ±â€¯SD patient age was 55.0 ±â€¯7.9 and 59.5 ±â€¯8.5 years in both groups, respectively (p = 0.001). There was a significant difference in the physical, social/family, emotional and functional statuses that were significantly higher in group I. One year postoperatively, the emotional well-being became insignificantly different, but other QoL parameters remained significantly different between both groups. Regarding EF, there was a significant difference between patients who underwent nerve-sparing (No. 29) and non nerve-sparing RC (No. 59) (p < 0.001). CONCLUSIONS: Which type of diversion is the best is still a controversial topic. Egyptian patients may prefer the continent UD to avoid the urostomy appliance and its associated daily-life constraints. Detailed patient counseling and active participation of the patient in selecting the treatment methods are important for better postoperative QoL.

Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.