Systemic corticosteroids in the treatment of warm autoimmune hemolytic anemia: A clinical setting perspective.

INTRODUCTION: There are unmet answers about the effect of the different forms of corticosteroids in the treatment of the warm autoimmune hemolytic anemia (WAIHA). We aimed to describe the initial response rate and the safety profile of different regimens and forms of parenteral corticosteroids versus the solo oral prednisolone as first-line strategies for newly diagnosed adult WAIHA. METHODS: We recruited 156 patients who treated with either oral prednisolone 1 mg/kg daily for 3 weeks or intravenous corticosteroids like dexamethasone 40 mg daily for 4 days, Methylprednisolone 1 g/day for 3 days, or Methylprednisolone 1 g/day for 5 days then followed by oral prednisolone 1 mg/kg/day for 3 weeks. Full clinical and laboratory evaluations were done every 3 days for 3 weeks. RESULTS: The primary outcome was the rate of response at the end of the third-week post treatment. The rate of response was more in the group started the treatment intravenously (81.6% versus 41.7% and p = 0.0001). Multivariate cox regression analysis proved the predictivity of intravenous corticosteroid therapy for initial response. CONCLUSION: The safety profile of the different forms and regimens of corticosteroids were comparable. Therefore, parenteral regimens can be used as a rescue treatment in severe cases of WAIHA.

Evaluation of circulating microRNAs-211 and 25 as diagnostic biomarkers of colorectal cancer.

Colorectal cancer is one of the most prevalent and deadly cancers worldwide. MicroRNAs are short single stranded non-coding RNAs that play important roles in carcinogenesis, tumor growth and tumor survival. Circulating microRNAs are increasingly becoming efficient and important biomarkers for several types of cancers. Herein, we aim to evaluate the diagnostic potentials of plasma microRNA-211 and microRNA-25 in colorectal cancer patients. Forty-four patients diagnosed with colorectal cancer and 40 healthy controls were recruited for the present study. Expressions of circulating microRNAs -211 and 25 were assessed by quantitative real-time polymerase chain reaction (RT-qPCR). Expression of transforming growth factor-beta, a key factor in tumorigenesis and a key inducer of epithelial to mesenchymal transition was assessed by enzyme-linked immunosorbent assay (ELISA) in patients' tissue and plasma. Our results demonstrated upregulated expressions of plasma microRNAs-211 and 25 correlated with the high transforming growth factor-beta (TGF-ß1) expression in patients. In addition, plasma levels were positively correlated with lymph node metastasis. Moreover, receiver operating characteristic analysis demonstrated the reliability of microRNAs-211 and 25 for discriminating colorectal cancer patients from healthy individuals. MicroRNA-211 and microRNA-25 might have a tumorigenic role in colorectal cancer and their plasma levels could be potential biomarkers in its diagnosis.

Analysis of Lamin B1, Vimentin and Anti-Ku86 as Prospective Biomarkers of Hepatocellular Carcinoma in Patients with Hepatitis C Virus Infection.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is the fifth most common malignancy and most frequently develops in patients with cirrhosis. Surveillance strategies are recommended in high-risk groups because early detection of small lesions improves the likelihood of curative treatment. This study investigated the prospective clinical significance of serum levels of anti-Ku86 and plasma levels of lamin B1and vimentin as early markers of HCC. METHODS: We recruited 74 patients at Assiut University Hospital-37 with HCC and 37 with chronic liver disease (liver cirrhosis patients)-and 36 age- and sex-matched healthy controls. Lamin B1 and vimentin mRNA expression levels were evaluated by reverse transcription-PCR and serum levels of anti-Ku86 were measured by enzyme-linked immunosorbent assay. RESULTS: Compared with liver disease patients and controls, HCC patients showed higher levels of lamin B1 mRNA (sensitivity, 96%; specificity, 65%), vimentin mRNA (sensitivity, 94%; specificity, 92%), and anti-Ku86 (sensitivity, 94%; specificity, 80%). LaminB1 levels were significantly higher in patients with a tumor size < 2 cm than in patients with tumors 2-5 cm and >5cm in size. Lamin B1 had significant positive correlations with alpha-fetoprotein (AFP) (P=0.034) and anti-Ku86 (P=0.002). Receiver operating characteristic curves for differentiating HCCfrom liver cirrhosis revealed a higher area under the curve(AUC).for vimentin than for AFP, lamin B1, and anti-Ku86 for the diagnosis of HCC (P<0.001). CONCLUSION: Circulating levels of anti-Ku86, lamin B1,and vimentin might be potential surrogate markers of HCC, either alone or in combination with AFP. However, independent and discriminative serological biomarkers with higher sensitivity and specificity are still needed for the early detection of HCC.

Frequency and Implications of myeloid-derived suppressor cells and lymphocyte subsets in Egyptian patients with hepatitis C virus-related hepatocellular carcinoma.

BACKGROUND AND AIM: Myeloid-derived suppressor cells (MDSCs) play a pivotal role in tumor immunity and induction of immune tolerance to a variety of antitumor effectors, including T lymphocytes. Herein, we tried to evaluate the frequency and clinical significance of MDSCs and different lymphocyte subsets in hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). METHODS: Four groups were enrolled; chronic HCV (CHC; n = 40), HCV-related liver cirrhosis (n = 40), HCV-related HCC (HCV-HCC; n = 75), and healthy control group (n = 20). The percentage of peripheral lymphocytes subsets and total MDSCs with their main two subsets; monocytic (M-MDSCs) and granulocytic (G-MDSCs) was evaluated by flow cytometry. RESULTS: The frequency of total MSDCs and M-MDSCs was significantly elevated in HCV-HCC especially patients with advanced stage HCC compared with those with early-stage HCC. The frequency of total MSDCs and M-MDSCs was positively correlated with ALT, AFP, and HCV viral load and negatively correlated with CD8+ T-cell frequency. CD4 + T cells were significantly decreased in HCV-HCC patients. The frequency of CD4 + T cells and CD8 + T cells was negatively correlated with AFP and AST, but not with albumin or HCV viral load. CONCLUSION: Taken together, our data suggest that MDSCs, M-MDSCs, and lymphocyte subsets are associated with the development and progression of HCV-related HCC.

Aggregated Throughput Prediction for Collated Massive Machine-Type Communications in 5G Wireless Networks.

The demand for extensive data rates in dense-traffic wireless networks has expanded and needs proper controlling schemes. The fifth generation of mobile communications (5G) will accommodate these massive communications, such as massive Machine Type Communications (mMTC), which is considered to be one of its top services. To achieve optimal throughput, which is considered a mandatory quality of service (QoS) metric, the carrier sense multiple access (CSMA) transmission attempt rate needs optimization. As the gradient descent algorithms consume a long time to converge, an approximation technique that distributes a dense global network into local neighborhoods that are less complex than the global ones is presented in this paper. Newton's method of optimization was used to achieve fast convergence rates, thus, obtaining optimal throughput. The convergence rate depended only on the size of the local networks instead of global dense ones. Additionally, polynomial interpolation was used to estimate the average throughput of the network as a function of the number of nodes and target service rates. Three-dimensional planes of the average throughput were presented to give a profound description to network's performance. The fast convergence time of the proposed model and its lower complexity are more practical than the previous gradient descent algorithm.

Nutrient supply systems and their effect on the performance of the Nile Tilapia (Oreochromis niloticus) and Lettuce (Lactuca sativa) plant integration system.

The main aim of this work is to study the effect of different nutrient supply systems and their effect on the performance of the Nile Tilapia (Oreochromis niloticus) and Lettuce (Lactuca sativa var. crispa) plant integration system. To achieve that, five treatments having different culture systems (T1: Aquaculture (control), T2: Hydroponics (standard requirement: N = 210, P = 31, K = 234, Mg = 48, Ca = 200, S = 64, Fe = 14, Mn = 0.5, Zn = 0.05, B = 0.5, Cu = 0.02 and Mo = 0.01 ppm), T3: Aquaponics without nutrients addition, T4: Aquaponics with supplementary nutrients (KNO3, 101 g L-1, KH2PO4, 136 g L-1, Ca(NO3)2, 236 g L-1, MgSO4, 246 g L-1, K2SO4, 115 g L-1 and chelates for trace elements) in water (EC is 800 ppm) and T5: Aquaponics with supplementary nutrients spray on plants) were carried out. The previous systems were operated at three flow rates, namely, 1.0, 1.5 and 2.0 L h-1 plant-1. The various water quality parameters, plant growth and fish growth were studied. The result indicated that the highest values of N, P, k, Ca and Mg consumption rate were found with T2 and 1.5 L h-1 plant-1 of flow rate. The root length, fresh and dry of shoot and root for lettuce plants grown in T2 system was better than those grown in different culture system (T3, T4 and T5). Different culture systems showed significant effect on fish growth in terms of weight gain, specific growth rate and feed efficiency ratio. Higher growth rate was observed in treatment T3 as compared to other treatments. The production costs ranged from 2820.5 to 4885.4 LE ($ = 30.92 LE) for all culture systems.

Biochar production under different pyrolysis temperatures with different types of agricultural wastes.

The main aim of this study is to determine the physical and chemical properties of biochar synthesized from different materials (straw rice, sawdust, sugar cane, and tree leaves) at different pyrolysis temperatures (400, 600, and 800 °C). The physical and chemical properties such as moisture content, water holding capacity, bulk density, and porosity; and pH, electrical conductivity (EC), organic matter, organic carbon, total nitrogen, potassium, phosphorus, calcium, magnesium, sodium, and sulfur were determined, respectively. The results show that the biochar yield decreased with increasing pyrolysis temperature, and the values of the analyzed properties varied depending on the type of biochar and pyrolysis temperature. The moisture content ranged from 1.11 to 4.18%, and the water holding capacity ranged from 12.9 to 27.6 g water g-1 dry sample. The highest value of bulk density (211.9 kg m-3) was obtained from sawdust at a pyrolysis temperature of 800 °C. The porosity values ranged from 45.9 to 63.7%. The highest values of pH and EC (10.4 and 3.46 dS m-1) were obtained from tree leaves at a pyrolysis temperature of 800 °C. Total organic matter ranged from 66.0 to 98.1%, total organic carbon ranged from 38.3 to 56.9%, and total nitrogen ranged from 0.4 to 1.9%. The highest values of phosphorus and calcium content (134.6 and 649.0 mg kg-1) were obtained from sugar cane at a pyrolysis temperature of 800 °C. The magnesium, sodium and sulfur content had ranges of 10.9-51.7, 1124-1703 and 3568-12,060 mg kg-1, respectively.

Effect of loading rate and source of energy on the drying parameters of the basil during drying.

The basil leaves were dried different sources of energy at different loading rates. Using hybrid solar drying compared to the conventional source of energy such as fossil and propane. Drying parameters were studied. Also, product quality was assessed under study treatments. The results indicated that the higher accumulated weight loss of basil leaves (75.56%) were obtained at 25 kg m-2 loading rate and solar drying system. The highest rate of the decrease in moisture content of basil leaves was happened at the 45 kg m-2 loading rates. Meanwhile, the lowest rate of the decrease in moisture content of basil leaves was found at 15 kg m-2 loading rates. The highest drying rate of basil leaves (219.54 gwater kg-1 h-1) was obtained at the loading rate of 15 kg m-2. The highest values of total chlorophyll and color of basil leaves 745.9 and 36.35 were found for solar dryer. The lowest values of total chlorophyll and color of basil leaves 703.5 and 31.66 were found for diesel dryer. The drying efficiency ranged from 33.98 to 40.33% for all batch loads. The highest essential oil yield obtained for solar dryer, the lowest essential oil yield occurred for diesel dryer. The highest value of volatile compounds with found for solar dryer. The total costs for basil drying were 19.73, 26.70 and 23.93 LE h-1 for solar, diesel and propane dryers, respectively. Also, the total costs of basil drying were 8.77, 13.15 and 12.27 LE kg-1 dried for solar, diesel and propane dryers, respectively.

Effect of adding nano-materials on the properties of hydroxypropyl methylcellulose (HPMC) edible films.

The bio-composite films based on Hydroxypropyl methylcellulose (HPMC) reinforced with silver nanoparticles (AgNPs) and Titanium oxide nanoparticles (TiO2-NPs) were developed. Some physical and mechanical properties: Tensile strength (TS), elongation (E), Young's elastic modulus (EM), water vapor permeability (WVP) and transparency were determined. Antibacterial properties of these films were also studied. The tensile strength values of HPMC film reinforced with Ag NPs and TiO2-NPs and HPMC without nanoparticles were 39.24, 143.87 and 157.92 MPa, respectively. Elongation of the HMPC film was less than the HPMC film reinforced with AgNPs and TiO2-NPs, the results were 2, 35 and 42%, respectively. Additionally, Young's elastic modulus of HMPC film was determined to be 19.62 MPa and the HPMC film reinforced with AgNPs and TiO2-NPs were 4.11 and 3.76 MPa, respectively. The values of WVP of HMPC film was higher than the HMPC film reinforced with AgNPs and TiO2-NPs, where they were 0.5076 × 10-3, 0.4596 × 10-3 and 0.4504 × 10-3 (g/msPa), respectively. Nano-composite films demonstrated strong antibacterial activity against tested pathogen bacteria in the contact surface zone. The antibacterial activites of AgNPs (~ 10 nm) at 80 ppm were more active than 20 and 40 ppm against foodborne pathogen i.e. Bacillus cereus and Escherichia coli, the inhibition zone diameters were 9 and 10 mm, respectively. As well, TiO2-NPs (~ 50 nm) at 80 ppm were more active than 20 and 40 ppm against B. cereus and Salmonella Typhimurium, the inhibition zone diameters were11 and 10 mm, respectively.

Study on the plant and fish production in the aquaponic system as affected by different hydraulic loading rates.

Aquaponics is the combined culture of fish and plants in recirculating aquaculture systems, considered to be an innovative, eco-friendly and sustainable technology. The effect of the hydraulic loading rate (HLR) on the performance of fish and plants in the aquapoinc system was the main aim of this study. Four hydraulic loading rates were applied, 1.2, 1.8, 2.4 and 3.0 m day-1 under stocking density tilapia fish of 5 kg m-3 and lettuce population of 25 plant m-2 for a period of January to March, 2023. Water parameters, plant and fish parameters were determined. The most important results revealed that the highest plant nutrients removal was at HLR of 2.4 m day-1. The highest value of water parameters were found at the HLR of 2.4 m day-1. Root length increased with increasing HLR. Fresh and dry shoot and root weight values were higher at 2.4 m day-1 compared to other treatments under study. Meanwhile, fish growth parameter showed higher values at the HLR of 3.0 m day-1 compared to other treatments. The highest values of weight gain, feed growth rate, specific growth rate and feed conversion ratio were 81.72 g, 1.36 g day-1, 1.88% day-1 and 1.20 g feed g-1 fish, respectively, for all treatments under study.

Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas.

BACKGROUND: Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis. However, there is a paucity of data regarding the imaging assessment of these lesions. AIM: To determine the characteristic EUS features of SPN and define its role in preoperative assessment. METHODS: This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics. RESULTS: One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: Fine needle aspiration (67/106; 63.2%), fine needle biopsy (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed. CONCLUSION: SPN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used does not appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis.

Flow patterns in circular fish tanks and its relations with flow rate and nozzle features.

The main aim of this research is to study the effect of flow rate, diameter and number of nozzles on the rotational velocity, impulse force and average velocity of water in circular fish tanks. The results indicated that, the rotational velocity increases with increasing flow rates from 5 to 75 m3 h-1 by using 10 and 15 mm nozzles diameter with nozzles number of 5, 10, 15, 20, 25 and 30. The same results were also obtained when 20 and 25 mm nozzle diameter with nozzles number of 3, 6, 9, 12 and 15 were used. The impulse force of water decreases with increasing nozzle diameter from 10.0 to 15.0 mm with 5, 10, 15, 20, 25 and 30 nozzles and from 20.0 to 25.0 mm with 3, 6, 9, 12 and 15 nozzles. When the nozzle diameter increased from 10 to 25 mm the impulse force of water decreased with 15 nozzles. The average velocity of water decreases with increasing nozzles diameter from 10.0 to 15.0 mm with 5, 10, 15, 20, 25 and 30 nozzles and from 20.0 to 25.0 mm with 3, 6, 9, 12 and 15 nozzles. When the nozzle diameter increased from 10 to 25 mm, the average velocity ranged from 1.07 to 48.76 cm s-1 for all treatments under study.

Effect of sono-pre-texturization on ß-lactoglobulin-anthocyanins energy appetizers.

The occurring of glycation reaction and protein-protein interaction in the energy appetizers caused browning and hardness instability while storing these appetizers, leading to the loss of consumer acceptability. Amassing among anthocyanins and proteins could mitigate the appetizers' instability. We, therefore, investigated the anti-aggregation and ant-glycoxidation impacts of mulberry anthocyanins combined with ultrasonic treatment (UT) pre-texturization in an energy appetizer model throughout storage via multi-dimensional methods, containing UPLC-ESI-MS/MS, SDS-PAGE, FTIR, texture analyser, and a molecular docking analysis. Results noted that UT-anthocyanins significantly downgraded the browning progress, advanced glycation end-products, and/or N-(carboxymethyl)-l-lysine intensities of energy appetizers after 45 d of storage at 45 °C. UT-anthocyanins also relegated the protein insolubility, accumulation, oligomerization, and glycoxidation throughout the late storage. A molecular docking analysis evidenced that cyanidin 3-O-glucoside and cyanidin 3-O-rutinoside networked with ß-lactoglobulin subunits via H-bonding and π-π forces. This binding hindered some glycoxidation residues of ß-lactoglobulin the lysyl residues. Finally, these findings recommended that the UT-anthocyanins could be employed as an encouraging antiglycative approach to alleviate AGEs-creation and other consequent undesirable fluctuations in protein-rich food patterns, thereby enhancing the energy appetizer's post-processing stability during storage.

Microstructural, Physicochemical, Microbiological, and Organoleptic Characteristics of Sugar- and Fat-Free Ice Cream from Buffalo Milk.

Ice cream is a popular dessert product across the world. Structure, body, taste, and odor properties are created by adding non-milk ingredients and milk ingredients. The main aim of the study is to decrease the caloric value of ice cream by using sugar and fat replacements. Ice cream treatments were investigated based on microstructural, chemical, physical, microbiological, sensory, and calorific values. Four different ice creams were used (control ice cream (SC1), ice cream with stevia (SC2), ice cream with sucralose (SC3), and ice cream with sorbitol (SC4)). The chemical properties in all treatments of ice cream were significantly recorded (p < 0.05). The highest sucrose and fat levels were detected in the SC1 treatment compared with the other treatments (p < 0.05). The lowest fat and sugar amounts were observed in the SC2, SC3, and SC4 treatments (p < 0.05). The highest viscosity, overrun, and hardness values (p < 0.05) were detected in the control ice cream. Total aerobic mesophilic bacterial counts were not significantly recorded between different ice cream treatments (p < 0.05). The sensory scores were not significantly affected by sweeteners and bulk agents in the different treatments. The highest calorific value was calculated in the SC1 samples (p < 0.05). On the other hand, the lowest calorific value was calculated in SC2, followed by the SC3 and SC4 treatments. In scanning electron microscopy (SEM), the gel exhibited a homogeneous structure with a fine network within the SC2, SC3, and SC4 treatments, as it contained a cohesive structure with small-sized pores.

Impact of Geographical Location on the Gut Microbiota Profile in Egyptian Children with Type 1 Diabetes Mellitus: A Pilot Study.

Purpose: To investigate the compositional and functional characteristics of T1DM-associated gut microbiota in two Egyptian cities and to study the geographical locality effects. Patients and Methods: This case-control study included 32 children with controlled T1DM and 16 controls, selected from two different regions of Egypt. The gut microbiota of both diabetic and control children was analyzed through 16S rRNA gene sequencing; this was done using the Illumina MiSeq platform. Results: Consistent findings among the diabetic children included significantly lower alpha diversity than the control children, as well as a lower mean Firmicutes/Bacteroidetes (F/B) ratio, and reduced proportions of Firmicutes and the genera Prevotella and Ruminococcus. In the diabetic children, there were also significantly enriched representations of Actinobacteria, Bacteroidetes, and Proteobacteria and the genera Lactobacilli, Bacteroides, and Faecalibacterium. When comparing the two diabetic groups, the Ismailia group (IsDM) was found to have a significantly higher F/B ratio and diversity indices, with resultant differences at the functional level. Conclusion: There are a number of consistent changes in the microbiota profile characterizing the diabetic groups irrespective of the geographical location including significantly lower alpha diversity, mean Firmicutes/ Bacteroidetes (F/B) ratio, and reduced proportions of Firmicutes and genera Prevotella and Ruminococcus. There are also significantly enriched representations of Actinobacteria, Bacteroidetes, and Proteobacteria and genera Lactobacilli, Bacteroides, and Faecalibacterium pointing to the greater driving power of the disease.

COVID-19 Infection in Patients with Comorbidities: Clinical and Immunological Insight.

AIM: Our study's objectives were to study the clinical and laboratory characteristics that may serve as biomarkers for predicting disease severity, IL-10 levels, and frequencies of different T cell subsets in comorbid COVID-19 patients. METHODS: Sixty-two hospitalized COVID-19 patients with comorbidities were assessed clinically and radiologically. Blood samples were collected to assess the T lymphocyte subsets by flow cytometry and IL-10 levels by ELISA. RESULTS: The most common comorbidities observed in COVID-19 patients were diabetes mellitus (DM), hypertension, and malignancies. Common symptoms and signs included fever, cough, dyspnea, fatigue, myalgia, and sore throat. CRP, ferritin, D dimer, LDH, urea, creatinine, and direct bilirubin were significantly increased in patients than controls. Lymphocyte count and CD4+ and CD8+ T-cells were significantly decreased in comorbid COVID-19 patients, and CD25 and CD45RA expression were increased. CD4+ and CD8+ regulatory T cells (Tregs) and IL-10 levels were significantly decreased in patients. CONCLUSIONS: Many parameters were found to be predictive of severity in the comorbid patients in our study. Significant reductions in the levels and activation of CD4+ and CD8+ T-cells were found. In addition, CD4+ and CD8+ Tregs were significant decreased in patients, probably pointing to a prominent role of CD8+ Tregs in dampening CD4+ T-cell activation.

Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions.

BACKGROUND: Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM: To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-ß), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. METHODS: This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs. RESULTS: The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively (P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance (P < 0.0001). In contrast, IL-1ß, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions. CONCLUSION: EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

Autoimmune Hepatitis: Shifts in Gut Microbiota and Metabolic Pathways among Egyptian Patients.

Autoimmune hepatitis (AIH) is a chronic inflammatory disorder with complex immunopathogenesis. Dysbiosis has been linked to many autoimmune diseases, but its detailed role in autoimmune hepatitis (AIH) still needs rigorous evaluation, especially in Egypt. We aimed to identify the shift in the gut microbiota profile and resultant metabolic pathways in AIH Egyptian patients compared to healthy individuals. Stool samples were collected from 15 AIH-naive patients and from 10 healthy individuals. The V3-V4 hyper-variable regions in16S rRNA gene was amplified and sequenced using Illumina MiSeq platform. Significantly lower bacterial diversity in AIH patients was found compared to the controls. A phylum-level analysis showed the overrepresentation of Firmicutes, Bacteroides, and Proteobacteria. At the genus level, AIH-associated enrichment of Faecalibacterium, Blautia, Streptococcus, Haemophilus, Bacteroides, Veillonella, Eubacterium, Lachnospiraceae and Butyricicoccus was reported in contrast to Prevotella, Parabacteroides and Dilaster, which were significantly retracted in such patients. Overall, the predicted metabolic pathways associated with dysbiosis in AIH patients could orchestrate the potential pathogenic roles of gut microbiota in autoimmune disease, though not in a disease-specific manner, calling for future large-scale studies.

Regulatory B Cells and Their Cytokine Profile in HCV-Related Hepatocellular Carcinoma: Association with Regulatory T Cells and Disease Progression.

Although regulatory B cells (Bregs) have been proven to play a suppressive role in autoimmune diseases, infections and different tumors, little is known regarding hepatocellular carcinoma (HCC), especially in hepatitis C-related settings. Herein, we analyzed the frequency of circulating Bregs, serum levels of IL-10, IL-35 and B-cell activating factor (BAFF) and investigated their association with regulatory T cells (Tregs) and disease progression in HCV-related HCC. For comparative purposes, four groups were enrolled; chronic HCV (CHC group, n = 35), HCV-related liver cirrhosis (HCV-LC group, n = 35), HCV-related HCC (HCV-HCC group, n = 60) and an apparently healthy control (Control-group, n = 20). HCC diagnosis and staging were in concordance with the Barcelona Clinic Liver Cancer (BCLC) staging system. Analysis of the percentage of Breg cells and peripheral lymphocyte subsets (Treg) was performed by flow cytometry. Serum cytokine levels of IL-10, IL-35 and B-cell activating factor (BAFF) were measured by ELISA. The frequency of Bregs was significantly higher in the HCV-HCC group compared to the other groups and controls. A significant increase was noted in late-HCC versus those in the early stages. The frequency of Bregs was positively correlated with Tregs, serum IL-10, IL-35 and BAFF. In conclusion, Peripheral Bregs were positively correlated with the frequency of Tregs, IL-10, IL-35 and BAFF, and may be associated with HCV-related HCC progression.

Increased frequency and FOXP3 expression of human CD8+CD25High+ T lymphocytes and its relation to CD4 regulatory T cells in patients with hepatocellular carcinoma.

The mechanism of action of CD8+CD25High+FOXP3+ T cells in hepatocellular carcinoma (HCC) has not been fully understood. Herein, the role of CD8+CD25High+FOXP3+ T cells in HCC was compared with that of CD4+CD25High+FOXP3+ regulatory T cells (conventional Tregs). Thirty-five patients with HCC and twenty age and sex-matched healthy adults (controls) were enrolled. The percentage of CD8+CD25High+FOXP3+ T cells and conventional Tregs in peripheral blood was measured by flow cytometry. Our results revealed that the percentage of peripheral CD8+CD25High+FOXP3+ T cells in HCC patients was significantly higher than controls (P = 0.005). The conventional Tregs showed the same trend with a higher level in HCC than controls (P < 0.0001). FOXP3 expression of CD8+CD25High+ T cells is higher than that of CD8+CD25low+ and CD8+CD25Negative T cells. The percentage of CD8+CD25High+FOXP3+ T cells positively correlated with that of conventional Tregs in HCC patients but not in controls. The higher alpha-fetoprotein positively correlated with the higher CD8+CD25High+FOXP3+ T cells and conventional Tregs (R2 = 0.481, P < 0.0001 and R2 = 0.249, P = 0.001, respectively). The frequency of both CD8+CD25High+FOXP3+ T cells and conventional Tregs was significantly increased in HCC with multiple lesions compared with those with one or two lesions. In conclusion: CD8+CD25High+FOXP3+ T cells similar to conventional Tregs might be used as biomarkers of HCC progression. Therapy targeting the peripherally expanded CD8+CD25High+FOXP3+ T cells may provide a novel perspective for HCC treatment.