Predictors of recurrence of peritoneal carcinomatosis among patients with colorectal cancer following cytoreductive surgery alone versus cytoreductive surgery plus HIPEC

Background: Peritoneal carcinomatosis (PC) is a lethal regional progression in patients with colorectal cancer (CRC). Treatment with complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) achieves better local control than systemic palliative chemotherapy. Objectives: To assess the efficacy on the prognosis of CRS and HIPEC compared with CRS only and to identify possible clinicopathological factors associated with the recurrence of PC. Methods: The present retrospective study included all colorectal carcinoma cases with PC subjected to CRS with or without HIPC from January 2009 to June 2018 at the National Cancer Institute (NCI), Cairo University, Cairo, Egypt. The outcome is evaluated in terms of recurrence-free survival (RFS) and its predictors. Results: Out of the 61 patients, 45 patients (73.8%) underwent CRS plus HIPEC, and 16 (26.2%) underwent CRS alone. The 1-year RFS was 55.7%, with a median of 12 months. The risk factors for recurrence identified in the univariate analysis were T4 primary tumor, high-grade, positive lymphovascular invasion (LVI), positive extracapsular nodal spread, and patients treated with CRS only, without HIPEC. In the multivariate analysis, the independent risk factors for recurrence were high grade and patients treated with CRS only. Conclusion: T4 primary tumor, high grade, positive LVI, and positive extracapsular nodal spread seemed to be important predictors of recurrence following the treatment of PC. Our study also demonstrated that the addition of HIPEC to CRS improved the RFS. (AU)

Why human prepuce is a valuable resource in science? Histological, ultrastructural, immunohistochemical and statistical analysis / ¿Por qué el prepucio humano es un recurso valioso en la ciencia? Análisis histológicos, ultraestructurales, inmunohistoquímicos y estadísticos

SUMMARY: This research was to examine the histological and ultrastructural characteristics of prepuce samples, as well as vimentin and S100 protein localization and statistical analysis. Urologists have long struggled with the prepuce, which is used to treat a variety of urethral problems. Skin biopsies were collected from the prepuce at the moment of circumcision and processed for light microscopy, electron microscope examination, immunohistochemical techniques, and statistical analysis in a total of six boys. Histologically, the prepuce epidermis displayed focal spiky ridges, which are saw-toothed interspersed with sulci, slight hyperpigmentation, looser connective tissue and plentiful vascular components. Immunohistochemically, the existence of melanocytes and Langerhans cells in the epidermis, as well as smooth muscles in the dermis, was stained positively for vimentin. Also, there was a positive reactivity of the Langerhans cells in the epidermis and around Meissner's corpuscles in the dermis for S100 protein staining. Ultrastructurally, the prepuce's intercellular gaps were widened, melanocytes rested on a folded basement membrane, and desmosomal content was reduced, with a prominent active euchromatic nucleus. Cytoplasmic projections were distended and elongated, and the interstitial blood vessels were surrounded by endothelial cells and rested on a basement membrane. There were also minimal collagen fibers in the interstitium. The prepuce's histological and ultrastructural features, as well as immunohistological studies using vimentin and S100 protein as intermediate filaments and statistical analysis, all demonstrated that it is a useful scientific resource.

RESUMEN: El presente trabajo de investigación se realizó para examinar las características histológicas y ultraestructurales de las muestras de prepucio, así como la localización y el análisis estadístico de la vimentina y la proteína S100. Los urólogos han intentado trabajar durante mucho tiempo con el prepucio, que se usa para tratar una variedad de problemas uretrales. Se recolectaron biopsias de piel del prepucio de seis niños en el momento de la circuncisión y se procesaron para microscopía óptica, examen con microscopio electrónico, técnicas inmunohistoquímicas y análisis estadístico. Histológicamente, la epidermis del prepucio mostraba crestas puntiagudas focales, intercaladas con surcos, hiperpigmentación leve, tejido conectivo más laxo y abundantes componentes vasculares. Inmunohistoquímicamente, la existencia de melanocitos y células dendríticas epidérmicas (células de Langerhans), así como músculo liso en la dermis, se tiñeron positivamente para vimentina. Además, hubo una reactividad positiva de las células dendríticas epidérmicas en la epidermis y alrededor de los corpúsculos del tacto (de Meissner) en la dermis para la tinción de la proteína S100. Ultraestructuralmente, los espacios intercelulares del prepucio se ensancharon, los melanocitos descansaban sobre una membrana basal plegada y el contenido desmosómico se redujo, con un núcleo eucromático activo prominente. Las proyecciones citoplasmáticas estaban distendidas y alargadas, y los vasos sanguíneos intersticiales estaban rodeados por células endoteliales y descansaban sobre una membrana basal. También había fibras de colágeno mínimas en el intersticio. Las características histológicas y ultraestructurales del prepucio, así como los estudios inmunohistológicos utilizando vimentina y proteína S100 como filamentos intermedios y el análisis estadístico, demostraron que es un recurso científico útil.

Cost-Effectiveness of HCV Core Antigen versus PCR for Monitoring Treatment Response in DAAS-Treated Egyptian Patients

PCR is currently the non-debatable proof for diagnosis of HCV infection as well as conclusion of treatment outcomes. HCV core antigen (HCVcAg) testing is a neglected, less expensive and less time consuming test that's presumed to achieve the same aims. The aim of this study is to find the cost-effectiveness of HCV core antigen testing in the monitoring of treatment response as an alternative to the gold-standard PCR test

Mangostanaxanthone VIIII, a new xanthone from Garcinia mangostana pericarps, α-amylase inhibitory activity, and molecular docking studies

ABSTRACT A new xanthone: mangostanaxanthone VIIII [1,3,5,6,7-pentahydroxy-2-(3-methylbut-2-enyl)-8-(3-hydroxy-3-methylbut-1-enyl) xanthone] (5) and four known xanthones: mangostanaxanthones I (1) and II (2), γ-mangostin (3), and mangostanaxanthone VII (4) were separated and characterized from the acetone fraction of Garcinia mangostana L., Clusiaceae (mangosteen) pericarps. Their structures were established based on various spectroscopic analyses in addition to HRMS and comparison with the literature. The α-amylase inhibitory potential of the isolated metabolites was evaluated. Compounds 1, 2, and 5 had the highest activity with % inhibition 72.5, 86.5, and 81.8, respectively compared to acarbose (97.1%, reference α-amylase inhibitor). The molecular docking study of the tested metabolites was estimated to shade up the rational explanation of the α-amylase inhibitory activity results. Moreover, the pharmacokinetic parameters were assessed using Swiss ADME. It is noteworthy that 1, 2, and 5 had similar binding poses as the X-ray crystal structure of acarbose, whereas the other metabolites possessed different binding mode that decreased their inhibitory capacity. Thus, these data reinforced the health benefit of mangosteen as an alternative medicine to help lowering the postprandial glucose absorption. Therefore, it could have a good potential for the treatment of diabetes.

Lipoxygenase inhibitors flavonoids from Cyperus rotundus aerial parts

ABSTRACT Cyperus rotundus L. (Suada, Sueda, family: Cyperaceae) is vastly spread in several world's subtropical and tropical regions. It had variable traditional uses and bioactivities. A new flavonol derivative: cyperaflavoside (myricetin 3,3',5'-trimethyl ether 7-O-β-D-glucopyranoside) and five flavonoids: vitexin, orientin, cinaroside, quercetin 3-O-β-D-glucopyranoside, and myrcetin 3-O-β-D-glucopyranoside were separated from the methanolic extract of C. rotundus aerial parts. Their structures were verified based on UV, IR, NMR (1D and 2D), HRESIMS, and comparison with literature. All metabolites were assessed for their 5-lipoxygenase inhibitory potential. All compounds possessed 5-lipoxygenase inhibitory potentials with IC50s 5.1, 4.5, 5.9, 4.0, 3.7, and 2.3 µM, respectively, in comparison to indomethacin (IC50 0.98 µM). These results supported the traditional uses of C. rotundus in treating inflammation and its related symptoms.

Plectraterpene, a new ursane-type triterpene ester and other steroids from the aerial parts of Plectranthus montanus

ABSTRACT A new ursane-type triterpene ester, plectraterpene [3β-(decanoyloxy)-19-hydroxy-urs-12-ene] and four known steroidal compounds have been isolated from the aerial parts of Plectranthus montanus Benth. (syn. Plectranthus cylindraceus Hochst. ex Benth.), Lamiaceae. The known compounds were stigmasterol, sitosteryl ferulate, cholest-5-en-3-O-β-D-glucopyranoside and stigmasterol-3-O-β-D-glucopyranoside. Compounds plectraterpene, sitosteryl ferulate and stigmasterol-3-O-β-D-glucopyranoside are reported for the first time from this plant whereas compound cholest-5-en-3-O-β-D-glucopyranoside first time from the genus. The structures of these compounds were determined through spectral analysis, including extensive 2D NMR data as well as chemical methods and comparison with literature.

Antioxidant α-amylase inhibitors flavonoids from Iris germanica rhizomes

ABSTRACT A new isoflavonoid glycoside, iridin A (9), along with eight known isoflavonoids: irilone 4'-methyl ether (1), irilone (2), irisolidone (3), irigenin S (4), irigenin (5), irilone 4'-O-β-D-glucopyranoside (6), iridin S (7), and iridin (8) were separated from Iris × germanica L., Iridaceae, rhizomes. The structural elucidation of these flavonoids was achieved with the aid of extensive spectroscopic techniques and comparing with the published data. They were estimated for their α-amylase and 1,1-diphenyl-2-picrylhydrazyl inhibitory capacities. Compounds 3, 5, and 9 showed α-amylase inhibitory activities with % inhibition 70.8, 67.5, and 70.5, respectively compared to acarbose (a reference α-amylase inhibitor). Moreover, 9 exhibited moderate antioxidant activity with IC50 8.91 µM.

Cucumol A: a cytotoxic triterpenoid from Cucumis melo seeds

ABSTRACT Phytochemical investigation of the MeOH extract of Cucumis melo L. var. reticulates, Cucurbitaceae, seeds led to the isolation of a new triterpenoid: cucumol A (27-hydroxy taraxerol-3β-ol), along with three known compounds: α-spinasterol and D:B-friedoolean-5-ene-3-β-ol. Their structures were established by extensive 1D (1H, 13C, and DEPT) and 2D (1H–1H COSY, HMQC, and HMBC) NMR, as well as IR and HRESIMS spectral analyses. Compound 3 displayed cytotoxic activity against L5178Y and Hela cancer cell lines with ED50 of 1.30 and 5.40 µg/ml, respectively compared to paclitaxel (0.07 and 0.92 µg/ml, respectively).

Cucumin S, a new phenylethyl chromone from Cucumis melo var. reticulatus seeds

ABSTRACTA new phenylethyl chromenone, cucumin S [(R)-5,7-dihydroxy-2-[1-hydroxy-2-(4-hydroxy-3-methoxyphenyl)ethyl]chromone] (1), along with five known compounds: 5,7-dihydroxy-2-[2-(4-hydroxyphenyl)ethyl]chromone (2), 5,7-dihydroxy-2-[2-(3,4-dihydroxyphenyl)ethyl]chromone (3), luteolin (4), quercetin (5), and 7-glucosyloxy-5-hydroxy-2-[2-(4-hydroxyphenyl)ethyl]chromone (6) were isolated from the EtOAc fraction of Cucumis melo var. reticulatus Ser., Cucurbitaceae, seeds. Their structures were determined by spectroscopic means (1D and 2D NMR), as well as HRESIMS, optical rotation measurement, and comparison with literature data. The isolated compounds 1–6 were assessed for their antioxidant activity using DPPH assay. Compounds 3, 4, and 5 showed potent activities compared to propyl gallate at concentration 100 µM.

Protective and therapeutic effects of cannabis plant extract on liver cancer induced by dimethylnitrosamine in mice

Hepatocellular carcinomas will emerge as a major form of malignancy in the coming decades. When these tumors are in advanced stages, few therapeutic options are available. Therefore, it is essential to search for new treatment modalities to fight this disease. Evaluate the possible protective and therapeutic effects of Cannabis extract on dimethylnitrosamine [DMNA]-induced hepatocarcinogenicity in mice. Seventy-five male mice were divided into five groups of 15 each: group I mice received corn oil only as the control group; group II mice were injected intraperitoneally with DMNA [10 microg/kg body weight] weekly for 12 weeks; group III mice were pretreated orally with cannabis extract [0.5 ml/kg body weight] every other day for two weeks before the injection of DMNA, and continued until the end of the experiment [12 weeks]; group IV mice were treated orally with cannabis extract every other day simultaneously with DMNA injection and continued until the end of the experiment; group V mice were treated orally with cannabis extract every other day after receiving the last intraperitoneal injection of DMNA. A real time PCR was used to quantify telomerase reverse transcriptase and caspase-8 m-RNA expression level

Serological detection of Toxoplasma gondii in chronic renal failure patients and renal transplant recipients

Toxoplasma gondii antibodies were detected in 78 patients with renal disease by ELISA. Patients were classified according to the renal status; chronic renal failure patients not on haemodialysis [G1=19], chronic renal failure patients on regular haemodialysis [G2=30], renal transplant recipient [G3=29] and 13 normal controls. Anti-Toxoplasma IgG and IgM antibodies were 36.8% and 10.5% in renal failure patients not on haemodialysis, 56.7% and 16.7% in patients on regular haemodialysis and 69% and 24.1% in renal transplant recipients versus 23.1% and 0% in controls with statistical significant difference for Toxoplasma IgG antibodies only. Anti-Toxoplasma IgG antibodies levels of G3 were lower than that of Gl. It was observed that the more the exposure to dialysis, the more the risk of toxoplasmosis. It was found that 85.71% of renal transplant recipient seropositive cases for anti-Toxoplasma IgM antibodies were detected in one year post-transplantation and 14.28% of cases after the first year of transplantation

Risk factors predisposing to toxoplasmosis in chronic renal failure patients and renal transplant recipients

This work evaluated risk factors predisposing to toxoplasmosis in chronic renal failure patients and renal transplant recipients. The present study included 91 cases classified according to their renal status into four groups; control group, renal failure patients not on haemodialysis, renal failure patients on regular haemodialysis and renal transplant recipients group. The age groups [<20] and [30-] had the highest positivity for anti-Toxoplasrna IgG and IgM antibodies in comparison to the other age groups. The results showed no sex difference in positivity rate for anti-Toxoplasma IgG and IgM in groups. There was no significant difference between groups regarding risk factors for contracting toxoplasmosis, clinical presentation suggestive of toxoplasmosis and diabetes mellitus. There was significant difference between all groups as regarding intake of immunosuppressiye drugs and blood transfusion

Retro-peritoneal versus trans-peritoneal approaches in elective abdominal aortic surgery in Suez Canal University Hospital

In the era of rapidly changing surgical techniques toward safety and more cost effectiveness, retroperitoneal approach for aortic surgery is gaining popularity. This study aimed at evaluating the antero-lateral retroperitoneal approach in elective aortic surgical procedures versus the standard trans-peritoneal approach in the setting of the Suez Canal University Hospital. Since 2001 the retroperitoneal approach for aortic surgery had been introduced in the Suez Canal University Hospital. The current retrospective study was conducted in the period between 1995 and 2005. All patients had elective aortic surgery either by retro or trans-peritoneal approaches were in the study. Preoperative parameters, intra and postoperative variables, morbidity and mortality were compared in between both groups. Ninety two patients were included in two study groups. Demographic and preoperative parameters were nearly matched. The only statistically significant differences between both groups were found in some of the intra and postoperative variables. No statistically significant differences were found regarding either fatal or non-fatal complications. Both trans-peritoneal and retroperitoneal approaches are comparable to each other according to surgical expertise of the operating surgical team. With increasing experience with the retroperitoneal approach, it would be a preferable option to be chosen for performing aortic procedures

Post appendectomy adhesive small intestinal obstruction, is conservative treatment of value

This study was a trial to predict which has to be done, to give a chance for conservative treatment or to operate immediately in patients presented with post-appendectomy adhesive intestinal obstruction. This is a hospital based retrospective study. The files of patients admitted to the Suez Canal University Hospital for adhesive intestinal obstruction from 1996 to 2006 were retrieved and studies. Fifty seven patients with post-appendectomy adhesive small intestinal obstruction were admitted in that period. Forty nine [86%] patients were operated upon; forty one of them [83.7%] had complete obstruction with single band adhesion, twenty seven [55%] patients had complicated obstruction needed intestinal resection, the other 22 [45%] patients had simple adhesiolysis. Eight [14%] patients improved with conservative treatment. No mortalities were encountered but 20 [74%] patients of those who had intestinal resection developed significant postoperative wound infection. Post-appendectomy adhesive small intestinal obstruction is a serious, unpredictable complication. It is usually complete obstruction caused by tight single band adhesion with unexpected spontaneous resolution. Early operative intervention is recommended strongly with post-appendectomy adhesive intestinal obstruction. Clinical assessment is of weak value in differentiating between simple and complicated obstruction

Post-traumatic stress disorder following road traffic accidents

Post traumatic stress disorder [PTSD] is a traumatic event that results in re-experience of the events, avoidance, emotional numbing and persistent symptoms of increased arousal. In addition, people have reported decreased satisfaction in every day activities, sexual life as well as lack of satisfaction in their friendship. Studies reported that road-traffic accidents [RTAs] are the most common causes of PTSD symptoms among the general population. The annual statistical medical record of Saudi Arabia relating to RTA reports that 140,280 survivors were admitted to the emergency department through the year 1425 H. Following this traumatic event the majority of those survivors may develop Post-Traumatic Stress Disorder [PTSD] that can delay their physical recovery and result in long-standing psychological, social and biological consequences. Victims of road traffic accidents who are at risk for developing this disorder need to be identified early to allow for early intervention and prevent greater impairment and restriction. The critical and psychiatric nurses are in an ideal position to identified treat, or refer patients with traumatic responses to psychiatric counseling. The nurse awareness of PTSD's risk factors or predictors allows her to critically evaluate symptoms that may begin to interfere with the resumption of daily activities. Given prompt intervention, most sufferers can recover fully and return to normal lives. Interventions can then be initiated before the onset of PTSD in hopes of preventing this debilitating disorder. Hence, this study aims to assess PTSD among patients who admitted to the King Fahd University Hospital 3-6 months following their exposure to traffic accidents and to identify the risk factors associated with the development of this disorder. The subjects of this study consisted of all patients who were exposed to traffic accidents and who were admitted to the emergency department, surgical, neurosurgical, and orthopedic ward of King Fahd University Hospital in the period range from 5 Jan to 20 Jun 2005. These patients were interviewed personally using the following scales: the Abbreviated Injury Scale, The impact of Evidence Scale, The Beck Depression Inventory, and the Taylor Manifest Anxiety Scale. In addition the patient completed a developed list of risk factors for post traumatic stress disorders. The results of the study show that 62.2%of the road accident persons had PTSD among them 18.9% suffer from severe PTSD. The most significant risk factors were, the patient age, level of education. Type of injury, the severity of physical injury, degree of anxiety and Depression

Correlation of Angiographic findings and Right [V1 - V3] versus left [V4 -V6] pre-cordial ST segmen depression in acute inferior wall myocardial infarction

Studies shows that ST depression in leads V1-V3 is generally believed to be associated with larger acute myocardial infarction and worser left ventricular function. Several studies have suggested that ST depression in V4-V6 confers a higher incidence of concomitant left anterior descending artery or multivessel disease. This study was performed to study the correlation between angiographic findings in form of affection of left anterior descending artery or number of vessels affected and Rt [V1]-V3] versus left [V4-V6] precordial ST segment depression in patients with acute inferior wall myocardial infarction. The study included 60 patients with 1[st] time acute inferior myocardial infarction. All of them received strep-tokinase [IV]. Resting EGG, serum cardiac enzymes and coronary angiography was done to all patients. We compared the data between patients with no ST depression in precordial leads and patients with ST depression in RT [V1-V3] precordial leads and patients with ST depression in left [V4-V6] precordial leads .The LVEF was significantly lower in patients with ST depression in left leads [p < 0.05] Significant LAD lesion was more in the same group [P < 0.01]. This group also showed higher incidence of three vessel disease [P < 0.01]. The mean peak CK level was higher in patients with ST depression in Right leads [P < 0.01]. So we concluded that patients with inferior wall myocardial infarction with no ST depression in precordial leads runs a benign course with low enzymatic release, normal ejection fraction, single vessel disease. Patients with Right precordial leads ST depression is characterized by high enzymatic release in comparison with patients with left precordial leads ST depression who show an aggressive course with low ejection fraction, multivessel disease, and more LAD artery affection. Thus we recommend that more attention should be paid to EGG analysis since this may affect the treatment strategy

Laparoscopic versus open appendicectomy: a prospective study

The benefits of laparoscopic appendicectomy are controversial, and the results of recent clinical studies have contradictory conclusions. A prospective study was performed to compare the results of laparoscopic [LA] and open appendicectomy [OA] in patients with signs and symptoms suggesting acute appendicitis who were seen by one surgical team. A total of 298 patients with clinical diagnosis of acute appendicitis underwent LA and 78 had OA. LA had a longer median operating time [63 minutes versus 40 minutes. The hospital stays were significantly short in LA. LA also reported less postoperative wound sepsis rate. The return to normal activity was an earlier in LA. The degree of appendiceal inflammation and doses of analgesics were similar in both groups. In 12 patients, the procedure was converted to OA. LA can significantly reduce hospital stay and decrease wound infection rate with quicker return to normal activities

Mycobacterial genital infections and female infertility

Eighty female patients with infertility due to tubal factor [whether primary or secondary] diagnosed on clinical, laboratory, radiological, and laparoscopic bases, were studied for mycobacterial infections of the fallopian tubes and the endometrium using microbiological and histopathological methods. Nine strains of genus mycobacteria were isolated from 9 cases of the studied group [11.25%]. Isolated mycobacterial strains were found to be : 6 Mycobacterium tuberculosis, 2 Mycobacterium bovis and the last one was found to be atypical mycobacterium. The isolated 8 strains of tubercule bacilli were sensitive at least to 3 of the following drugs Rifampicin, isoniazid, ethambutol, streptomycin and paraaminosalysilic acid [PAS] respectively. The atypical strain of the mycobacteria was resistant to the mentioned drugs. From 12 histopathological samples showing granulomas suggestive of tuberculosis; 8 mycobacterial strains were isolated whereas no histopathological findings were detected in the case from whom atypical strain was isolated

Minute ventilation sensing rate modulated pacemaker reliability, sensitivity, and utility of cardiopulmonary stress test for optimal rate programming

Among the different sensors available to date for rate responsive pacing, the minute ventilation sensor is claimed to be the most physiological. This study aims to verify the reliability, physiological sensitivity and rate modulating ability of minute volume as a sensor for rate responsive pacing, together with the utility of cardiopulmonary stress test [CPX] to optimize pacing rate. In addition, comparison between the cardiac performance during exercise in fixed-rate VVI versus that in rate responsive modes of pacing was studied. We implanted the META MV in 5 patients [3 males and 2 females, mean age 36. 4 +/- 1.6 yrs, NYHA class 1] affected by CHB. These patients were followed for 3-12 months. Treadmill symptoms-limited exercise test was performed for each patient in both adaptive and rate responsive modes using Bruce protocol. Cardiopulmonary parameters were measured on 1-minute interval. During rate responsive mode exercise capacity improved significantly in comparison to UVI adaptive mode: anaerobic threshold [AT] increased from 1.15 +/- 0.13 to 1.34 +/- 0.16 1/min [16.7%; P 0.005]; time of AT increased from 7 +/- 1.9 to 9.8 + 2.14 minutes [40%; P 0.0025]; VO2 max increased from 1.15 +/- 0.17 to 1.7 +/- 0.18 1/min [12.5%; P]. Sensitivity of the sensor determined from the correlation between VO2 and pacing rate was very strong during the maximal incremental Bruce test [mean r value 0.9650 +/- 0.02]. This correlation was also maintained during our laboratory, brief, low and discontinously graded test [mean r value: 0.9338 +/- 0.01]; however, the response was weaker when compared with that of 15 normal controls. In order to identify the optimal pacing rate which is the lowest rate able to attain the best cardiac performance with preservation of liner correlation between VO2 and heart rate - we repeated for each patient the CPX several times with different slope rates. In 3 patients the optimal pacing rate was 1 or 2 slopes less than the suggested one. In one patient, the slope needed to be reduced after 3 months of implantation; this was due 10 improvement of physical fitness. Follow-up confirmed a correct pacing status. Rate responsive pacing improves cardiac performance belter than fixed-rate VVI pacing. The MV sensor is reliable and highly sensitive, but has poor rate modulating ability. The optimal rate response is not always that suggested by Adaptive mode; moreover, it may change with time. The CPX is mandatory to program and properly follow-up the patients