Transforming growth factor-beta1 gene expression in hepatocellular carcinoma: a preliminary report

The transforming growth factor [TGF]-beta signalling pathway plays a dual role in hepatocarcinogenesis. It has been recognised for its role as a tumour suppressor as well as a tumour promoter depending on the cellular context. The aim of this study was to investigate the clinical significance of serum TGF-beta1 level and TGF-beta1 messenger RNA [mRNA] in the peripheral blood of liver cirrhosis and hepatocellular carcinoma [HCC] patients as noninvasive biomarkers in diagnosing HCC. Twenty patients were allocated to each of the liver cirrhosis and HCC groups, in addition to 20 healthy volunteers. TGF-beta1 gene expression in peripheral blood was quantitated using real-time polymerase chain reaction [PCR], while serum TGF-beta1 was analysed using enzyme-linked immunosorbent assay [ELISA]. TGF-beta1 gene expression was significantly lower in HCC patients [median 0.401 [0.241-0.699] fold change] than in liver cirrhosis patients [median 0.595 [0.464-0.816]] [p = 0.042] and normal controls [median 1.00 [0.706-1.426] fold change] [p = 0.001]. TGF-beta1 gene expression showed significant positive correlation with serum TGF-beta1 [r = 0.272, p = 0.036] and significant negative correlation with alpha-fetoprotein [AFP] [r = ?0.528, p = 0.001]. Receiver operating characteristic [ROC] analysis was conducted for TGF-beta1 gene expression in comparison with AFP. The area under the curve for TGF-beta1 gene expression was 0.688 [95% CI = 0.517-0.858] [p = 0.042] and AFP was 0.869 [95% CI = 0.761-0.976] [p = 0.001]. The sensitivity and specificity of TGF-beta1 gene expression were 65% and 75%, respectively, at a cutoff value of 0.462 fold change. TGF-beta1 gene expression in the peripheral blood may be used as a molecular marker for the diagnosis of HCC. Additional studies on a large-scale population are necessary to gain greater insight into the impact of TGF-beta1 gene expression in the pathogenesis of HCC

Diagnosis of exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy

Introduction: Medical thoracoscopy increases the diagnostic yield in patients with non-diagnosed pleural effusion when thoracocentesis and closed pleural biopsy [CPB] are non-diagnostic. Chest ultrasound [US] is a very useful imaging method for pleural diseases and the technique of ultra sound-guided cutting biopsy with a tru-cut needle has been well described

Aim of the work: The aim of this work was to diagnose exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy

Subjects and methods: Forty patients with, non-diagnosed exudative pleural effusion admitted to the chest department, Alexandria university hospital, were enrolled after obtaining informed consents. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations including prothrombin activity and INR, biochemical, pathological and microbiological evaluation of the pleural aspirate and radiological evaluation. Then the patients were divided [randomly] into 2 groups each containing 20 patients. Pleural biopsies were performed using medical rigid thoracoscopy on group 1 and ultrasound guided tru-cut pleural biopsy on group 2

Results: The mean age in-group I was 55.0 +/- 13.05 years and in-group II was 52.60 +/- 17.77 years. There was no statistically significant difference between the two groups regarding age, sex, smoking, marital status and past medical conditions. There was no statistically significant difference between the two groups regarding radiological findings. There was no statistically significant difference between the two groups regarding the pleural fluid analysis. There was no statistically significant difference between the two groups regarding the gross pleural findings. In group II non- specific pleurisy was found in 5 [25.0%] patients [by thoracoscopy 1 of them was finally diagnosed as metastatic deposits from adenocarcinoma of unknown primary, one was confirmed to be tuberculous pleurisy and the remaining 3 cases were confirmed to be non- specific pleurisy]. As regards complications in-group I, local wound infection occurred in 1 [5.0%] patient, and empyema occurred in 1 [5.0%] patient. In-group II, local wound infection occurred in 1 [5.0%] patient, and empyema occurred in 1 [5.0%] patient

Conclusion: It is better to use thoracoscopy in cases of undiagnosed exudative pleural effusion presented with a sufficient amount of pleural fluid to avoid lung injury while inserting the trocar. Whereas, ultrasound guided tru-cut pleural biopsy may be used in cases of undiagnosed exudative pleural effusion presented with thickened pleura but with an insufficient amount of pleural fluid

Probe microphone real ear insertion gain verification in children

The application of probe-microphone measurements to children is one of the most useful new developments in pediatric hearing aid selection. They offer a reliable method to verify hearing aid selection decisions. To assess the matching between real ear insertion gain [REIG] and prescribed target gain according to the desired sensation level [DSL] formula. This study included 40 ears of 30 children aged between 4 to 12 years with different degrees of hearing loss. They were fitted with linear hearing aids [10 binaural and 20 monaural]. Real ear unaided response [REUR], and real ear aided response [REAR] were measured. The real ear insertion gain was then calculated and compared to the prescribed target gain. There were 26 ears [of 19 children] failed to be within 10 dB of the DSL target gain at one or more frequencies from 500-3000Hz. Among these 26 ears who failed to achieve the DSL target gain, there were 16 ears [61.5%] found to have a flat audiogram and 13 ears [50%] had profound hearing loss. The difference in hearing threshold level was found to be of no clinical value in predicting the likelihood of failure. After appropriate modifications in hearing aid fitting, out of the 16 children [22 ears] who attended for hearing aid modifications, 18 ears [82 %] achieved a satisfactory gain within 10dB of the DSL target at all frequencies up to 3000Hz. No audiometric index was of clinical value in predicting those cases that required insertion gain measurements to ensure an adequate hearing aid prescription. The number of children who fail to achieve adequate gain with their initial hearing aid fitting is very high. These children have a wide range of degree and configuration of hearing loss. The routine measurement of real ear insertion gain in all first-time fittings would result in greatly improved amplification in many patients. More research in the field of pediatric hearing aid fitting is recommended to ensure delivery of adequate amplification to infants and young children

Manometric eustachian tube function tests in children with ventilation tubes

In this study, manometric Eustachian tube function tests were performed repeatedly at ten days, one month, three months and nine months after ventilation tubes insertion in 20 children with persistent otitis media effusion [OME]. Opening and closing pressures [passive tubal function] and active tubal function were measured. There was a significant increase in opening pressure. The closing pressure followed a similar pattern but the increase did not reach the statistically significant level. No significant change in tubal function group was found during the follow up sessions and remained in the same poor level. There was a positive significant correlation between opening and closing pressures and ET function grouping in all follow up sessions

effect of contralateral white noise on transient evoked otoacoustic emissions in different age groups

Transient evoked otoacoustic emissions [TEOAEs] can be suppressed by simultaneous contralateral sound stimulation, this suppression is mediated by the normal olivocochlear bundle. The aim of this study is to propose normative data for different age groups and gender. TEOAEs were recorded with and without contralateral white noise [WN]. The results revealed that TEOAE echo response decreased with age. Contralateral WN suppressed emission amplitude and the amount of suppression decreased significantly with increased age with a significant negative correlation between the amount of TEOAE suppression and age. The study concluded that TEOAEs recording during contralateral acoustic stimulation provide rapid, noninvasive and objective means of investigating the medial olivocochlear efferent fibers in humans

Vestibular function in cochlear implant patients

Cochlear implants have a dramatic impact on the lives of their recipients as well as their family and friends; however, there is a risk of vestibular function affection after cochlear implantation reported. The present study was conducted to evaluate the vestibular system in cochlear implant candidates. A total of 20 adult post lingually deaf cochlear implant candidates were examined. The vestibular function was assessed using electronystagmography. The results revealed that vestibular affection was found in 65% of patients preoperatively. The incidence of vestibular dysfunction was 16.6% postoperatively. The study concluded that the incidence of vestibular dysfunction following cochlear implant is remarkably lower than that reported

Imbalance between free radical propagation and some antioxidants in patients with cataract

The relation of oxidative stress to the occurrence of cataract remains to be undetermined and must be clarified. So, the aim of this work was to study the effect of O2-free radical and some antioxidants in the pathogenesis of senile and diabetic cataract. This work was carried on 30 patients and 10 healthy subjects as control. They were 23 males and 17 females. Their ages ranged from 50 to 64 years. Patients were classified into senile cataract, diabetic without cataract and diabetic cataract groups. Each group included 10 patients. The results of this work showed that, in patients with senile cataract, were non-significant increase of fasting serum glucose [FSG] and serum total bilirubin [serum T. bilirubin] compared with the control group. Serum lipid peroxide [S. LP] and serum ceruloplasmin [S. Cp] were. significantly increased [P<0.05] while plasma superoxide dismutase [SOD] and serum uric acid were significantly decreased [P<0.05] compared with the control group. Moreover, diabetic patients with and without cataract showed a significant increase of FSG, S. total bilirubin. S. LP, S. Cp, and S. uric acid [P<0.05] while plasma SOD was significantly decreased [P<0.05] compared with the control group. Comparative study of the diabetic cataract versus senile cataract and diabetic without cataract, our results showed a significant increase of FSG, S. LP, S. total bilirubin and S. Cp, while there was significant decrease of plasma SOD in diabetic cataract compared with both senile cataract and diabetic without cataract [P1<0.05 and P2<0.05], respectively. S. uric acid was significantly increased in diabetic cataract compared with senile cataract group [P1<0.05] while it was non-significantly increased compared with diabetic without cataract group. Also, aqueous humor study of diabetic cataract group versus senile cataract group showed that LP and uric acid were significantly increased [P<0.05] while SOD was significantly decreased [P<0.05]. Correlation study revealed that, age was significantly and positively correlated with LP, but negatively correlated with SOD both in serum and aqueous in all patient groups. FSG was significantly and directly correlated with serum and aqueous LP, uric acid, S. total bilirubin, and S. Cp in diabetics with and without cataract. Moreover, serum and aqueous LP was significantly and inversely correlated with serum and aqueous SOD in all patient groups, while, it was positively correlated with S. total bilirubin, and S. Cp in diabetics with and without cataract. We could conclude that the imbalance between generation of O2-free radical and plasma SOD may have an etiological implication in the occurrence of cataract

Study of atrial natriuretic peptide in patient with bronchial asthma and chronic obstructive pulmonary diseases

The present study was carried out to study the changes in plasma atrial natriuretic peptide [ANP] in asthmatic children and in cases with chronic obstructive pulmonary disease [COPD] and to correlate these changes with the ventilatory and cardiac functions in the COPD group. About 105 subjects were selected from Pediatric and Chest Departments, Benha University Hospital. They were classified into 20 asthmatic children [Group A[1]], who were reinvestigated 4 weeks after treatment [Group A[2]]. Their age ranged from 1.5 to 11 years old. This group of patients was compared with 15 healthy children matched for the same ages and sex. Another 60 patients with COPD were subclassified into 3 subgroups. Subgroup I: included 20 cases on hospital admission with acute infective exacerbation [subgroup la], those cases were reinvestigated 6 weeks after medical treatment [subgroup Ib]. Subgroup II included 20 patients with COPD cor-pulmonale and right-sided heart failure. Subgroup III: included 20 patients with COPD without cor-pulmonale. Their age ranged from 40 to 74 years old. This group of patients were compared with 10 healthy subjects matched for the same ages and sex. For all groups, plasma ANP was done while ventilatory functions and echocardiography was done for COPD group only. The main results of this study, showed that plasma ANP was significantly elevated in asthmatic children compared with the control group but, it was significantly higher in subgroups A[1] in comparison to subgroup A[2]. In the COPD group, ANP was significantly elevated in all subgroups. The highest level in subgroup la, the lowest level was in subgroup III. ANP was significantly elevated in subgroup II in comparison to Ib and III subgroups. Also, ANP was correlated with mean pulmonary artery pressure [PAP], surface area of right atrium [RASA], right atrial diameter [RAD], right ventricular diameter [RVD] and right ventricular anterior wall [RVAW] diameter. The decrease of ANP in subgroup Ib was associated with improvement in the ventilatory and cardiac functions. We could conclude that; ANP was elevated and correlated with the severity of the disease in both asthmatic and COPD cases. Also, it was correlated with the degree of PAP, right atrial and right ventricular dimensions. So, ANP may give a new meaning in the future for the treatment of both asthmatic and COPD cases

Potential role of cytokines as predictors in infection induced premature rupture of membranes; I-colony stimulating factor one [CSF -1] in premature rupture of membranes whether term or preterm

Acute bacterial intraamniotic infections are an important cause of perinatal morbidity and death. Although early diagnosis and aggressive treatment are believed to decrease the ill effects of intraamniotic infection, this goal is frequently difficult to achieve because the infection may not be clinically apparent before delivery in all patients. In this respect, the current study was designed to assess the potential role of CSF-l as a predictor of infection induced rupture membrane whether term or preterm. Collectively 75 amniotic fluid samples were obtained through caesarian section [C.S.] route of delivery. Fifty of them were from women suffering from premature rupture of membrane [PROM] [25 preterm and 25 full term] as well as 25 full term women with intact membranes served as controls. Bacterial cultures, chlamydial LPS antigen, mycoplasma and CSF-l detections revealed a significant association of bacterial infections and CSF-l with PROM deliveries [term and preterm] compared to the controls. A significant increase in CSF-l values were observed among PROM cases compared to the controls. CSF-l values were higher among preterm cases than full term ones and among positive amniotic fluid bacterial culture cases compared to negative culture ones. The highest CSF-l values were with ordinary bacterial infections and the least were with mycoplasmal and ureaplasmal ones

Potential role of cytokines in infection induced premature rupture of membranes; II- interleukin-6 in the amniotic fluid in cases of premature rupture of membranes whether term or preterm

The study aimed at evaluating the role of IL-6 in infection induced premature rupture of membranes [PROM]. 75 pregnant women at labor were the subjects of the study. Group I, included 25 preterm PROM cases, gp II included 25 full term PROM cases and group III included 25 full term with intact membranes [controls]. Amniotic fluid was collected through caesarean section route of delivery. Bacterial culture, chlamydial LPS antigen, mycoplasma detection and IL-6 quantitation, all except mycoplasma revealed, significantly higher values among PROM cases compared to the controls. They revealed to be good diagnostic tools to assess the microbial state of amniotic fluid. IL-6 recorded a significant constant level of 1050 pg/ml among all preterm PROM cases regardless the bacterial results. We conclude that lL-6 determination could be a good predictor of infection induced PROM

Potential role of cytokines in infection induced premature rupture of membrane; III- interleukin one beta in premature rupture of membranes whether term or preterm

The study was conducted upon 75 pregnant women delivering by caesarean section [CS] route. Group I [n=25] included preterm premature rupture of membranes [PROM] cases [20-37 wks of gestation], Group II [n=25] included full term PROM cases [38-42 wks], Group III [n=25] included the controls who were full term with intact membranes submitted to elective CS. Routine bacteriologic culture, chlamydial LPS and mycoplasmal detection and IL-1beta estimation of amniotic fluid samples revealed a significantly elevated IL-1beta values among preterm PROM cases with positive bacterial culture compared to negative culture cases. Also full term PROM cases revealed significantly elevated IL-1beta values among positive chlamydial amniotic fluid samples. To conclude IL-1beta could be a potential marker in infection induced PROM cases. Further studies arc warranted to clarify the role of IL-1beta receptor antagonist as a causal therapy in PROM cases

Serum iron, ferritin and transferrin in patients with ischemic heart disease

To shed more light on the relationship between ischemic heart disease and iron, serum iron parameters [iron, ferritin and transferring] were estimated in fifty ischemic heart patients [15 stable angina-15 crescendo angina and 20 acute Myocardial Infarction. MI]. Their ages ranged 43-58 years- Ten healthy subjects, matched with patients for age and sex, sevred as control group. Echocardiographic studies [ejection fraction [EF] and end systolic volume [ESV] together with peak serum creatine phosphokinase [CPK] were done for each case of infarction to correlate these variables with the corresponding serum iron parameters. compared to controls, ischemic heart patients had highly significant increase of serum iron [103.5 +/- 25.6 vs 79.6 +/- 19.2, p<0.01] and serum ferritin [94.7 +/- 54.2 vs 44.4 +/- 11.0. p<0.01] whereas they showed insignificant increase of serum transferrin [273.8 +/- 83.8 vs 244.1 +/- 56.4, p<0.05]]. Subgroup analysis showed that there was statistically significant increase in serum iron and ferritin but not transferrin in patients with stable and unstable angina while in cases with acute MI, there was significant increase in all serum iron parameters. correlation studies showed that serum iron and ferritin but not transferrin were strongly correlated with peak CPK. EF and ESV. Patients with acute MI who had complicated in-hospital course showed significant higher value of serum iron. ferritin. transferrin, CPK and ESV but they had a significant lower EF than non-complicated cases. In conclusion, serum iron and ferritin were significantly higher in ischemic heart patients while serum transferrin was significantly higher only in patients with acute MI In the infarction group, the higher the serum iron and ferritin, the larger is the size of infarction, the worser is the in-hospital course and the more impaired is the systolic function. Thus, the present study might give a new meaning for the emerging role of iron in ischemic heart disease

Shoulder involvement in hemiplesia

Ninety-three adult hemiplegic patients secondary to cerebral thrombo-embolic manifestations were followed to determine the frequency of the different types of shoulder involvement. Painful shoulder was present in 44% of the cases, shoulder hand syndrome in 18.7% and brachial plexus lesion in 5.4%. There was no sex influence on the development of such complication, similarly, the side of hemiplegia did not affect their rate of occurrence. Most of shoulder complications [90.5%] took place in severely spastic patients. Painful shoulder conditions continued to occur irrespective of the duration of hemiplegia, while it seems that shoulder hand syndrome ceased to develop after 5-6 months from onset of hemiplegia

Peripheral nerves involvement in patients with diabetic retinopathy and diabetic patients without diabetic retinopathy

Twenty diabetic patients with diabetic retinopathy and another 20 without retinopathy were examined to determine the degree of neuropathic changes in their peripheral nerves. The degree of neuropathic involvement in the retinopathic group was higher than that of the non-retinopathic group. Possible etiological factors were discussed

Acupuncture analgesia in obstetric surgery in Alexandria. A preliminary report on 19 cases of lower segment caesarean sections and one case of abdominal hysterotomy and stcrilizatoin

Acupuncture analgcsisa was tried in 19 cases of lower segment Caesorean sections and one case of abdominal hysterotomy and sterilization. The technique Proved to be simple, safe and reliable especially when traditional anaesthsia proves to be risk

Plasma cortisol and synacthen test after oral contraceptives

Thirty women receiving Gyn-Anovlar were studied for plasma cortisol level. Ten of them were examined before and after Gyn-Anovlar therapy for basal cortisol and were injected intramuscularly with 250 mg mg of Synacthen. There was a significant rise of plasma cortisol and the patients responded normally to the injection of Synacthen indicating a good adrenal reserve function. The remaining 20 patients were already taking the pills for periods ranging from 8 to 9 months. Their plasma cortisol level was not statistically different from those taking the pills for six months