Environmental gas impact on the emission volume of X-rays near the interface in the variable pressure scanning electron microscopy.

In this paper, our previously developed model to account for the secondary X-ray fluorescence and absorption effects near the interface of two adjacent materials in a high-vacuum scanning electron microscope (Zoukel & Khouchaf, 2014) is adapted and extended to experimental conditions of low-vacuum mode (in the presence of a gaseous environment in the SEM analysis chamber). The position shifting effect of the two Gaussian peaks issued from the first derivative equation that can fit the experimental low-vacuum EDS profiles is investigated. The impact of the medium gas on the emission volume of secondary X-rays near the interface is qualitatively discussed. Water vapour and helium are successively used as gas environment, in order to link the resolution of microanalysis profiles with the effects of the X-ray fluorescence and absorption phenomenon. A close agreement between Monte Carlo simulation and experimental results is found.

Impact of a national nutritional support programme on loss to follow-up after tuberculosis diagnosis in Kenya.

SETTING: Undernourishment is prevalent among tuberculosis (TB) patients. Nutritional support is given to TB patients to prevent and treat undernourishment; it is also used to improve treatment outcomes and as an incentive to keep patients on treatment. OBJECTIVE: To determine whether nutritional support is associated with a reduction in the risk of loss to follow-up (LTFU) among TB patients in Kenya. DESIGN: This was a retrospective cohort study using national programmatic data. Records of 362 685 drug-susceptible TB patients from 2012 to 2015 were obtained from Treatment Information from Basic Unit (TIBU), a national case-based electronic data recording system. Patients who were LTFU were compared with those who completed treatment. RESULTS: Nutrition counselling was associated with an 8% reduction in the risk of LTFU (RR 0.92, 95%CI 0.89-0.95), vitamins were associated with a 7% reduction (adjusted RR [aRR] 0.93, 95%CI 0.90-0.96) and food support was associated with a 10% reduction (aRR 0.90, 95%CI 0.87-0.94). Among patients who received food support, the addition of nutrition counselling was associated with a 23% reduction in the risk of LTFU (aRR 0.77, 95%CI 0.67-0.88). CONCLUSION: Nutritional support was associated with a reduction in the risk of LTFU. Providing nutrition counselling is important for patients receiving food support.

Promising sub-100 nm tailor made hollow chitosan/poly(acrylic acid) nanocapsules for antibiotic therapy.

Herein, we report on the preparation of ultra-low sized (<100 nm in diameter) biodegradable polymeric capsules for potential applications as nanocontainers in antibiotic therapy. Hollow nanospheres based on the chitosan/poly(acrylic acid) pair are elaborated via (i) the layer-by-layer technique using gold nanoparticles (20 and 60 nm in size) as sacrificial templates, (ii) loading with amoxicillin, a betalactam antibiotic, and (iii) removal of the gold core via cyanide-assisted hydrolysis. Size, dispersity and concentration of the resulting nanocapsules are easily tuned by the nanoparticle templates, while wall thickness is controlled by the number of polyelectrolyte bilayers. Electrostatic interactions between the protonated amine groups of chitosan and the carboxyl groups of poly(acrylic acid) act as the driving attraction force allowing easy and fast design of robust and well-ordered multilayer films. Successful hydrolysis of the gold core is evidenced by time-dependent monitoring of the gold spectroscopic signature (absorbance at 519 nm and 539 nm for the gold nanoparticles with 20 and 60 nm, respectively). Crosslinked capsules are also prepared through crosslinking of the chitosan chains with glutaraldehyde. Chitosan-based nanocapsules are finally evidenced to be promising drug delivery vehicles of amoxicillin trihydrate with tuneable properties such as entrapment efficiency in the range of 62-75% and 3.5-5.5% concerning the drug loading.

Gas effect on the emission and detection of the backscattered electrons in a VP-SEM at low energy.

The effect of the electron beam skirting on the emission and detection of the backscattered electrons (BSE) in a low vacuum scanning electron microscope is investigated at low energy regime. Monte Carlo computed dependencies of the BSE distribution on the water vapor and air pressure shown a significant increase of the extent of the BSE exit zone. The pressure variation has however a little effect when helium gas is used. A new approach based on the comparison between the sizes of the skirt and the BSE exit zone on the specimen surface provides a useful tool to determine the operating pressure range that ensures minimal degradation of the lateral resolution in BSE imaging mode.

Evaluation of antibiotic mix in Non-instrumentation Endodontic Treatment of necrotic primary molars.

AIM: To compare the clinical and radiographic success rates of an antibiotic mix consisting of metronidazole, minocycline and ciprofloxacin (3Mix-MP) and another mix where minocycline was replaced with clindamycin (3Mix-MP-R) in non-instrumentation endodontic treatment (NIET) of necrotic primary molars and to determine the effect of root resorption on the success of the treatment. MATERIALS AND METHODS: Forty-two necrotic mandibular primary molars from 22 healthy children were randomly assigned to either mixture. Blinded clinical evaluation was conducted after 1, 3, 6 and 12 months by the operator, and blinded radiographic evaluation was conducted at 6 and 12 months follow-ups by other two investigators with inter-examiner reproducibility of 0.95. RESULTS: Overall success rates of 3Mix-MP and 3Mix-MP-R were 80.96% and 76.20% respectively, with no statistically significant difference. Radiographically, resorption of more than one third of the root length had a lower failure rate with no statistically significant difference (p<0.5). CONCLUSION: Primary teeth with necrotic pulp can be treated with 3Mix-MP or 3Mix-MP-R irrespective of the degree of root resorption.

Correlates of default from anti-tuberculosis treatment: a case study using Kenya's electronic data system.

BACKGROUND: In 2012, the World Health Organization estimated that there were 120,000 new cases and 9500 deaths due to tuberculosis (TB) in Kenya. Almost a quarter of the cases were not detected, and the treatment of 4% of notified cases ended in default. OBJECTIVE: To identify the determinants of anti-tuberculosis treatment default. DESIGN: Data from 2012 and 2013 were retrieved from a national case-based electronic data recording system. A comparison was made between new pulmonary TB patients for whom treatment was interrupted vs. those who successfully completed treatment. RESULTS: A total of 106,824 cases were assessed. Human immunodeficiency virus infection was the single most influential risk factor for default (aOR 2.7). More than 94% of patients received family-based directly observed treatment (DOT) and were more likely to default than patients who received DOT from health care workers (aOR 2.0). Caloric nutritional support was associated with lower default rates (aOR 0.89). Males were more likely to default than females (aOR 1.6). Patients cared for in the private sector were less likely to default than those in the public sector (aOR 0.86). CONCLUSION: Understanding the factors contributing to default can guide future program improvements and serve as a proxy to understanding the factors that constrain access to care among undetected cases.

Sphincter saving and abdomino-perineal resections following neoadjuvant chemoradiation in locally advanced low rectal cancer.

BACKGROUND: The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients with low rectal cancer to have sphincter preservation. STUDY AIM: To compare the oncologic and functional outcome in patients with locally advanced low rectal cancer treated by neoadjuvant chemoradiation followed by sphincter saving resection (SSR) against those who underwent abdomino-perineal resection (APR). PATIENTS AND METHODS: A total of 111 patients with low rectal cancer were included in the study. Sixty-one consented patients who prospectively underwent SSR, from Jan 2008 to Jan 2013, and a retrospective group, formed of 50 patients, selected from cases seen at NCI, with comparable demographic, clinical and pathologic criteria, who underwent APR from Jan 2003 to Jan 2008. All lesions were <5 cm from anal verge. All 111 patients received preoperative chemoradiation and total mesorectal excision. RESULTS: All tumors were located at a median of 3.6 cm (range 2.5-4.5 cm) for the SSR group, and 3.5 cm (range 2.5-4.6 cm) for the APR group, from the anal verge. The median follow-up was 34 months (range 1-60 months) for both groups. The difference in disease recurrence and OS between the APR and SSR groups were both statistically insignificant. CONCLUSION: In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR, this might be attributed to the small sample size and short follow up period. However, patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence.

Evaluation of the frequency and pattern of local recurrence following intersphincteric resection for ultra-low rectal cancer.

INTRODUCTION: Abdomino-perineal resection has been the standard treatment for rectal tumors located ≤5cm from the anal verge. Recently, intersphincteric resection became a valid option which preserves the bowel continuity with better functional outcome. AIM: Is to evaluate the oncological and functional outcome alongside the associated surgical morbidity in patients with T1-3 rectal cancer, who underwent intersphincteric resection (ISR). PATIENTS & METHODS: Between the years 2006 and 2011, 55 patients with invasive rectal adenocarcinoma, T1-3 lesions, located 2-5cm from the anal verge underwent ISR with total mesorectal excision. When inevitable, complete. ISR was performed, otherwise partial ISR was done. All T3 patients underwent total meso-rectal excision (TME) while some had lateral lymph node dissection (LND) with concomitant pelvic autonomic nerve preservation (PANP). RESULTS: Among the 55 patients, 21 (38.1%) patients were T1-2 and 34 (61.9%) patients were T3. The tumor location range was 0-5cm from the anal verge (median 2.3cm). Partial or complete ISR was done for 35 (63.6%) and 20 (36.4%), respectively. Patients were followed for a median of 1.5 years (range 1-4.6 years). The 3 year local recurrence and distant metastasis free rates were 85.2% and 85.6%, respectively. All the 3 local recurrences occurred in T3 patients group, and had positive circumferential resection margins. Overall 3-year disease-free survival was 82.6%; while the overall 3-year survival was 88.7%. CONCLUSION: Intersphincteric resection with TME does not affect the local recurrence or overall survival rate in early rectal cancer T1-2 & 3, with preservation of bowel continuity and better life quality.

OLA1 protects cells in heat shock by stabilizing HSP70.

The heat-shock response is an evolutionarily conserved cellular defense mechanism against environmental stresses, characterized by the rapid synthesis of heat-shock proteins (HSPs). HSP70, a highly inducible molecular chaperone, assists in refolding or clearance of damaged proteins, thereby having a central role in maintaining intracellular homeostasis and thermotolerance. To date, induction of HSP70 expression has been described extensively at the transcriptional level. However, post-translational regulation of HSP70, such as protein stability, is only partially understood. In this study, we investigated the role of OLA1 (Obg-like ATPase 1), a previously uncharacterized cytosolic ATPase, in regulating the turnover of HSP70. Downregulation of OLA1 in mammalian cells by either RNAi or targeted gene disruption results in reduced steady-state levels of HSP70, impaired HSP70 induction by heat, and functionally, increased cellular sensitivity to heat shock. Conversely, overexpression of OLA1 correlates with elevated HSP70 protein levels and improved thermal resistance. Protein-protein interaction assays demonstrated that binding of OLA1 to the HSP70 carboxyl terminus variable domain hinders the recruitment of CHIP (C-terminus of Hsp70-binding protein), an E3 ubiquitin ligase for HSP70, and thus prevents HSP70 from the CHIP-mediated ubiquitination. These findings suggest a novel molecular mechanism by which OLA1 stabilizes HSP70, leading to upregulation of HSP70 as well as increased survival during heat shock.

Coiling of ruptured tiny cerebral aneurysms, feasibility, safety, and durability at midterm follow-up, and individual experience.

BACKGROUND AND PURPOSE: The tiny size of cerebral aneurysms represents one of the challenging facets for endovascular treatment, with a high risk for intraoperative rupture (IOR). We report on the treatment of tiny ruptured saccular cerebral aneurysms by coil embolization. All cases were that of £ 2-3 mm aneurysms with at least one of the dimensions < 2 mm. MATERIALS AND METHODS: Between April 2008 and December 2010, we performed a retrospective analysis of nine consecutive cases of tiny aneurysms treated by coil embolization in our institution. RESULTS: Coil embolization was successfully performed in nine cases, whereas in one case, intraoperative rupture (IOR) of the fundus was encountered before complete obliteration of the aneurysm expected to be achieved with two coils. Complete occlusion (in n = 7 aneurysms) or near-complete immediate occlusion (in n = 2 aneurysms) was achieved. A total of 18 coils was used for coiling of the nine aneurysms, wherein five aneurysms were coiled with two coils each, two aneurysms with three coils each, and two aneurysms with only one coil each to achieve accepted results. Balloon assistance was used in three cases. Although a minimal coil projection in the parent vessel was seen in three cases, no untoward clinical complications were seen. At mean follow-up (6.7 months, interquartile range (IQR) 3-12 months), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) in nine patients demonstrated persistent complete occlusion in six of the aneurysms; one aneurysm showed marked filling of the fundus, and two showed neck remnant but did not need retreatment. All patients with available follow-up were independent in day-to-day activities with a modified Rankin score (mRS) of 0 or 1. CONCLUSIONS: Coil embolization of tiny ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of such aneurysms is essential to achieve technical success while avoiding complications.

A phase 2 study of the combination of gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer previously treated with anthracyclines with/without taxanes.

BACKGROUND AND OBJECTIVES: Many patients with relapsed metastatic breast cancer are pre-treated with taxanes and anthracyclines, which are usually given in the neoadjuvant/adjuvant setting or as first-line treatment for metastatic disease. The primary objective of this study was to determine the overall response rate for combination treatment with gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer who had relapsed after receiving one adjuvant/neoadjuvant or first-line metastatic chemotherapy regimen containing an anthracycline with/without a taxane. Secondary endpoints included duration of response, time to progression, one-year survival probability, and toxicity. DESIGN AND SETTING: A single-arm, open-label, phase 2 study conducted at 17 investigative sites in Egypt. PATIENTS AND METHODS: treatment consisted of gemcitabine (1250 mg/m2) on Days 1 and 8 and cisplatin (70 mg/m2) on Day 1 of each 21-day cycle. Treatment continued until disease progression or a maximum of 6 cycles. RESULTS: Of 144 patients all were evaluable for safety and 132 patients were evaluable for efficacy. The overall response rate was 33.3% and 45.5% of the patients with stable disease as their best response. The median time-to-progression was 5.1 months and the one-year survival probability was 73%. The most common grade 3/4 adverse events were nausea/vomiting (20.1%), neutropenia (19.4%), anemia (13.9%), asthenia (11.1%), diarrhea (9.7%), stomatitis (7.6%), leucopenia (7.6%), and thrombocytopenia (6.2%). twelve (8.3%) patients had serious adverse events. CONCLUSIONS: The results of this study indicate that gemcitabine and cisplatin were active and generally well tolerated in pretreated patients with locally advanced or metastatic breast cancer.

Carotid angioplasty and stenting without protection devices: safety and efficacy concerns--single center experience.

PURPOSE: Against the background of the increasing dilemma in the scientific community regarding protected versus unprotected carotid artery stent (CAS) placement and the disputed points in interpreting the results of scientific studies as well as the difficulty in conducting such randomized controlled studies, this article gives a review of experiences with carotid stent placement without the use of protection devices. METHODS: This series comprised 133 consecutive patients with 136 carotid stenoses of which 128 carotid arteries (94%) were either symptomatic (93 out of 136 = 68.4%) or had a greater than 70% stenosis (35 out of 136 = 25.7%) and 8 out of 136 were asymptomatic and had stenoses between 50% and 70%. Patients underwent neurologic and sonographic evaluation before the procedure and during follow-up (mean 18 months). RESULTS: Primary stent placement was carried out in 110 out of 136 lesions and predilatation was necessary before stent deployment in 26 lesions,. Neurologic periprocedural complications included 3 disabling and 1 non-disabling strokes. During the follow-up period there were 6 deaths all unrelated to the carotid disease and no major strokes. The degree of stenosis decreased from a mean of 81% to a mean of 12.3% immediately after the procedure, 22 patients were defined as restenosis of which 9 were symptomatic. CONCLUSIONS: Carotid stent placement without the use of distal protection devices was found to be a safe and effective procedure with a relatively low incidence of periprocedural complications.

Prophylactic prosthetic reinforcement of midline abdominal incisions in high-risk patients.

BACKGROUND/AIM: Incisional hernia is one of the major elements of morbidity after abdominal surgery, with high incidence in vertical midline abdominal incisions. However, the risk of developing an incisional hernia can be increased due to the patient's related factors; therefore, more consideration has to be given to the choice of incision, wound closure and wound healing to protect against incisional hernia, especially in high-risk patients. In this study, we used prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients to detect whether fixing the wound with mesh is risky on a short-term basis and whether it is protective on a long-term basis. PATIENTS AND METHODS: From October 2000 to December 2002, 40 high-risk patients liable to develop postoperative incisional hernia underwent elective abdominal operations through midline abdominal incisions at the Department of Surgery, Gastroenterology and Laparoscopic Unit, Tanta University Hospital, Egypt. They were randomly divided into two groups; group A: patients for whom the midline abdominal incisions were closed by conventional method and reinforced by subfascial polypropylene mesh (20 patients); and group B: patients for whom the midline abdominal incisions were closed by conventional method only (20 patients) with a follow up period of more than 20 months. RESULTS: There was no significant difference (P = 0.075) in both groups regarding the age, sex and the average risk factor. Twenty-three patients (57.5%) presented with more than one risk factor (11 in group A and 12 in group B). The upper midline abdominal incisions were reported in 33 patients (19 upper and 14 extended upper). There was no significant difference between the overall local and systemic complications in both groups (P = 0.4082). However, the subcutaneous seroma and chronic wound pain were greater in patients with prophylactic mesh than those without mesh. One group A patients (5%) and three group B patients (15%) developed postoperative incisional hernia during the follow up period. CONCLUSION: Prophylactic subfascial non-absorbable mesh reinforcement of midline closure in high-risk patients can be used safely and effectively to provide extrinsic strength of the wound without relying too much on the defective development of its own intrinsic strength and to prevent subsequent incisional hernia. There was no risk in the use of the mesh regarding local and systemic complication. However, the final statement should await the outcomes of the long-term follow up of the studied cases.

Alternate routes for children with difficult central venous access.

BACKGROUND: Some children requiring chemotherapy, total parenteral nutrition, or repeated blood sampling for long periods have no more axillary, internal jugular, external jugular, saphenous, or femoral veins available for cannulation. In such patients, the central venous system can still be accessed via alternate routes e.g. the azygos vein, the gonadal vein or the inferior epigastric vein. PATIENTS AND METHODS: We report the use of: 1) The inferior epigastric vein for placement of the catheter into the IVC in 20 patients. 2) The right gonadal vein for placement of the catheter using a retroperitoneal approach in five pediatric patients. 3) The second and third right intercostal veins for placement of the catheter by right intrapleural thoracotomy in five pediatric patients. Pre-procedural assessment of the patency of these veins was done using colour Doppler ultrasonography and confirmation of occlusion of common sites used for central venous access. RESULTS: A total of 38 implantable venous access devices (IVAD) were inserted in 30 patients. The average age at operation was 1.4 years (range 1 month to 12 years). Infection was seen in two patients, venous thrombosis in two. The average longevity of IVAD is 6.5 months. Recovery from the procedure was uncomplicated and the patients were able to receive complete intravenous medication or nutritive mixtures after the insertion of the catheter. CONCLUSION: The knowledge of alternate routes to obtain central venous access for children requiring chemotherapy, total parenteral nutrition, or repeated blood sampling for long periods is critically important, and the azygos system, right gonadal vein or the inferior epigastric vein can be used when standard accessible veins are unavailable.

Consumer impact of an interactive decision aid for rectal cancer patients offered adjuvant therapy.

OBJECTIVE: There is increasing interest in the use of decision aids (DAs) to facilitate patient involvement in clinical decisions. This study explored the views of patients with colorectal cancer and participants in a community bowel screening service regarding an interactive DA concerning adjuvant treatment for rectal cancer, and the impact of the aid on knowledge, anxiety, attitudes and preferences for treatment options. METHOD: Fourteen patients with colorectal cancer participated in four focus groups. Eighty-nine participants in a community bowel screening service completed a questionnaire before and 1 week after viewing the DA. Thirty were randomly selected to participate in a telephone interview to obtain qualitative feedback about the DA. RESULTS: Focus group participants reported using information to evaluate their doctor's care and expertise, or to prepare themselves for future symptoms and side-effects. Most supported the use of a DA and preferred pie charts to convey risk information. Within the community sample, anxiety remained stable and knowledge increased after exposure to the DA. Almost all participants found the DA useful and easy to understand, and felt it would make the process of decision making easier. CONCLUSION: A DA regarding adjuvant therapy for rectal cancer appears to be valued and to produce positive outcomes. A randomized controlled trial of this intervention is now required.

Diuretic contrast-enhanced magnetic resonance urography versus intravenous urography for depiction of nondilated urinary tracts.

Diuretic contrast-enhanced magnetic resonance urography (MRU) is analogous to conventional intravenous urography (IVU) and, hence, designated as excretory MRU. It is performed with a T1-weighted fast gradient-echo sequence to obtain breath-hold, dynamic MRU after intravenous injection of low-dose furosemide (5-10 mg) and gadolinium (Gd) chelate. The combination of Gd and furosemide is the key for achieving a uniform distribution of the contrast material inside the entire urinary tract. It provides high-resolution images of nondilated urinary tracts and information about the renal function. This pictorial essay reviews the technical aspects and practical consideration of diuretic Gd-enhanced MRU and underlines its diagnostic capability in comparison with IVU in the depiction of nondilated collecting systems. We discuss its potential applications, as in young patients with anatomic anomalies, patients with renal transplants, patients allergic to iodinated contrast medium, and avoiding multimodality work-up in the evaluation of kidney donors and patients with renal and extrarenal tumor diseases.

Role of penile vascular insufficiency in erectile dysfunction in renal transplant recipients.

The objectives of this study were to define the role and haemodynamic features of penile vascular insufficiency in impotent renal transplant recipients (RTR) as well as to establish the possible vascular risk factors for impotence in these patients. A total of 54 RTR (35 impotent and 19 potent) and 21 potent healthy subjects were included in this study. All patients were assessed clinically and by measurement of serum creatinine, serum bilirubin, cyclosporine blood levels, haemoglobin and total serum cholesterol. All subjects were subjected to intracavernous injection of 20 microg prostaglandin E1 followed by colour Duplex sonographic examination. Our results showed that impotent RTR were significantly more likely than potent RTR to have hypertension, diabetes and hypercholesterolaemia (P<0.05). Arterial occlusive disease was identified in 42.9% of impotent RTR. Findings suggestive of veno-occlusive dysfunction were found in 68.6% and 26.3% of impotent and potent RTR, respectively (P=0.003). Unilateral ligation of the internal iliac artery has a negative role on haemodynamic parameters compared to unilateral end-to-side anastomosis to external iliac artery in impotent RTR (P<0.05). Impotent RTR receiving more than one antihypertensive drug showed significant decrease in basal peak systolic velocity (PSV), dynamic PSV, erectile angle and cavernosal artery diameter compared to those receiving one drug (P<0.05). In conclusion, penile vascular insufficiency appears to play a substantial role in the pathogenesis of impotence in transplant patients. Anastomosis of the graft to external iliac artery could preserve the potency to some degree. Antihypertensives should be reduced as much as possible to avoid their negative effects on erectile function.

Telomerase activity in bilharzial bladder cancer. Prognostic implications.

Background: Bladder cancer is a common malignancy in Egypt and other developing countries in which infection with Schistosoma haematobium is prevalent. Bladder cancer caused by bilharziasis has different clinical and biological characters than that observed in the western world. In this study, we used the TRAP technique to estimate telomerase activity in bilharzial bladder cancer specimens and we correlated the findings with other clinical and pathological findings. Patients and methods: Bladder cancer specimens were obtained from 57 patients who underwent radical cystectomy and pathological diagnosis was obtained in all patients. Tissue samples were frozen in liquid nitrogen and stored at -80 degrees C. Telomerase activity by PCR-ELISA technique was measured using TRAP technique. Results: Our patient group included 45 males and 12 females with a median age of 49 years. The majority of our patients (35/57) have squamous histology and they have proven bilharzial history shown in the pathology specimens. Stage P3b was encountered in 29/57 patients whereas thirty-five patients have grade II tumors. The majority of our patients (41/57) were negative for pelvic nodes metastases. Telomerase activity was detected in 27/57 patients (47.4%). The mean level of telomerase was 0.85+/-0.77 in positive patients and 0.029+/-0.025 in negative patients. The expression of telomerase and its mean level in patients above age of 60, in males and in those with squamous pathology, higher grade of tumors or positive node was higher than those without but the difference did not reach statistical significance (P>0.05). Alternatively, expression was significantly higher in those with stages (P1-P3a) compared with P3b-P4a disease stages (66.6% vs. 37.1, P=0.03). Conclusion: Telomerase activity is increased in bilharzial bladder cancer although to a lesser degree than that reported for TCC in the western world, which could be explained, by different biological behavior or different assay methods. Further larger studies with more number of patients are still needed to determine its potential value for early detection and possible use as a therapeutic target.

Plasma bcl-2 and nitric oxide: possible prognostic role in patients with metastatic breast cancer.

Interest in translational studies on breast cancer is presently devoted to identifying biological predictors of disease prognosis and response to treatment. In this study, we determined the plasma levels of bcl-2 and nitric oxide in 45 patients with metastatic breast cancer using an ELISA technique and correlated them with clinical and biological factors that may affect the outcome of disease. The results were as follows. The mean level of bcl-2 was 278.44 +/- 383.2 U/L compared with 64.42 +/- 14.4 U/L (p = 0.007) for controls. Levels of bcl-2 were higher in patients less than 50 yr old, premenopausals., GIII tumors, positive nodes, ER positive tumors (p = 0.6, 0.5, 0.9, 0.4, and 0.005, respectively). The site of metastatic disease and the number of metastatic sites did not show statistically significant influences over bcl-2 levels. Furthermore, there was a trend, although not significant, toward improvement of survival in patients with higher levels of bcl-2. The mean level of the nitric oxide (NO) was 297.12 +/- 220.54 microM compared with 13.91 +/- 1.1 microM for controls (p = 0.003). The levels were higher in patients over 50 yr, postmenopausal patients, those with visceral deposits, grade III tumors, positive lymph nodes, and those with disease-free survival of less than 6 mo following primary treatment (p = 0.1, 0.2, 0.1, 0.09, 0.4, and 0.08 respectively). Furthermore, there was no correlation between NO levels and survival (r = 0.002). This study demonstrates a potential role for NO and bcl-2 as prognostic factors in patients with metastatic breast cancer. However, larger studies with more patients together with a comparison of serum levels (ELISA) and tissue levels (MOAb) are still required.