Return to training in soccer players after anterior cruciate ligament reconstruction: reflections and considerations.

This clinical and rehabilitative overview focuses on the return to unrestricted sporting activity, aiming to consolidate the scientific evidence surrounding the structural progression of athletes, particularly footballers, undergoing anterior cruciate ligament reconstruction (ACLR). A multidisciplinary approach necessitates a shared language and standardized methodologies. Unfortunately, significant disparities persist in the structural strategies guiding the decision-making process for returning to on-field activities, the latter stages of rehabilitation, and subsequent restoration of technical and tactical football abilities. Divergences in definitions, terminologies, and rehabilitation protocols can substantially influence final outcomes. Presently, scientific consensus studies regarding the decision-making process during the final stages of on-field rehabilitation are lacking. Nevertheless, this overview outlines and defines pivotal language parameters crucial for effective communication and the seamless integration of clinical and rehabilitative data among the diverse professionals involved in facilitating the athlete's return to peak performance. In conclusion, the successful resumption of competitive sporting activities for footballer's post ACLR demands a collaborative decision-making approach encompassing various professionals. Additionally, it necessitates a cohesive transition from rehabilitation to on-field work, aiming at reinstating athleticism, technical prowess, and tactical acumen.

Developing a mortality risk prediction model using data of 3663 hospitalized COVID-19 patients: a retrospective cohort study in an Egyptian University Hospital.

PURPOSE: Since the declaration of COVID-19 as a pandemic, a wide between-country variation was observed regarding in-hospital mortality and its predictors. Given the scarcity of local research and the need to prioritize the provision of care, this study was conducted aiming to measure the incidence of in-hospital COVID-19 mortality and to develop a simple and clinically applicable model for its prediction. METHODS: COVID-19-confirmed patients admitted to the designated isolation areas of Ain-Shams University Hospitals (April 2020-February 2021) were included in this retrospective cohort study (n = 3663). Data were retrieved from patients' records. Kaplan-Meier survival and Cox proportional hazard regression were used. Binary logistic regression was used for creating mortality prediction models. RESULTS: Patients were 53.6% males, 4.6% current smokers, and their median age was 58 (IQR 41-68) years. Admission to intensive care units was 41.1% and mortality was 26.5% (972/3663, 95% CI 25.1-28.0%). Independent mortality predictors-with rapid mortality onset-were age ≥ 75 years, patients' admission in critical condition, and being symptomatic. Current smoking and presence of comorbidities particularly, obesity, malignancy, and chronic haematological disorders predicted mortality too. Some biomarkers were also recognized. Two prediction models exhibited the best performance: a basic model including age, presence/absence of comorbidities, and the severity level of the condition on admission (Area Under Receiver Operating Characteristic Curve (AUC) = 0.832, 95% CI 0.816-0.847) and another model with added International Normalized Ratio (INR) value (AUC = 0.842, 95% CI 0.812-0.873). CONCLUSION: Patients with the identified mortality risk factors are to be prioritized for preventive and rapid treatment measures. With the provided prediction models, clinicians can calculate mortality probability for their patients. Presenting multiple and very generic models can enable clinicians to choose the one containing the parameters available in their specific clinical setting, and also to test the applicability of such models in a non-COVID-19 respiratory infection.

Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience.

Landmark artery identification in the neurovascular bundle (NVB) is important for nerve-sparing in radical prostatectomy. We aimed to investigate intraoperative angiography using indocyanine green and near-infrared fluorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to identify the NVB, visualise vascularisation and haemostasis, and preserve erectile function. Our retrospective, unicentric study was performed in consecutive localised prostate cancer RARP patients (stage T1/T2, prostate-specific antigen < 10 ng/ml) who underwent ICG-NIRF angiography in France (2016-2021). When ready to dissect the NVB, the anaesthesiologist intravenously injected ICG (3 ml); the surgeon used alternating standard light or fluorescence to optimise NVB visualisation and facilitate microdissection. Primary outcomes: safety and feasibility of ICG-NIRF. Secondary outcomes: functional erectile dysfunction (Sexual Health Inventory for Men (SHIM) questionnaire) over 9 months, proportion of bilateral NVBs identified, ICG-related complications. Standard descriptive statistics were used; t test determined the significance of changes in SHIM scores versus baseline. Ninety-one patients received intraoperative angiography. The NVB was identified in all cases, without difficulties. No ICG-related complications or allergies were observed. There was no significant difference in the SHIM score at 9 months compared with baseline (p = 0.331), and erectile dysfunction returned to baseline levels in almost all patients. Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identification of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should confirm preliminary results.

SMPDL3b modulates radiation-induced DNA damage response in renal podocytes.

The kidneys are radiosensitive and dose-limiting organs for radiotherapy (RT) targeting abdominal and paraspinal tumors. Excessive radiation doses to the kidneys ultimately lead to radiation nephropathy. Our prior work unmasked a novel role for the lipid-modifying enzyme, sphingomyelin phosphodiesterase acid-like 3b (SMPDL3b), in regulating the response of renal podocytes to radiation injury. In this study, we investigated the role of SMPDL3b in DNA double-strand breaks (DSBs) repair in vitro and in vivo. We assessed the kinetics of DSBs recognition and repair along with the ATM pathway and nuclear sphingolipid metabolism in wild-type (WT) and SMPDL3b overexpressing (OE) human podocytes. We also assessed the extent of DNA damage repair in SMPDL3b knock-down (KD) human podocytes, and C57BL6 WT and podocyte-specific SMPDL3b-knock out (KO) mice after radiation injury. We found that SMPDL3b overexpression enhanced DSBs recognition and repair through modulating ATM nuclear shuttling. OE podocytes were protected against radiation-induced apoptosis by increasing the phosphorylation of p53 at serine 15 and attenuating subsequent caspase-3 cleavage. SMPDL3b overexpression prevented radiation-induced alterations in nuclear ceramide-1-phosphate (C1P) and ceramide levels. Interestingly, exogenous C1P pretreatment radiosensitized OE podocytes by delaying ATM nuclear foci formation and DSBs repair. On the other hand, SMPDL3b knock-down, in vitro and in vivo, induced a significant delay in DSBs repair. Additionally, increased activation of apoptosis was induced in podocytes of SMPDL3b-KO mice compared to WT mice at 24 h post-irradiation. Together, our results unravel a novel role for SMPDL3b in radiation-induced DNA damage response. The current work suggests that SMPDL3b modulates nuclear sphingolipid metabolism, ATM nuclear shuttling, and DSBs repair.

Crosstalk Between SMPDL3b and NADPH Oxidases Mediates Radiation-Induced Damage of Renal Podocytes.

Patients undergoing radiotherapy (RT) for various tumors localized in the abdomen or pelvis often suffer from radiation nephrotoxicity as collateral damage. Renal podocytes are vulnerable targets for ionizing radiation and contribute to radiation-induced nephropathies. Our prior work previously highlighted the importance of the lipid-modifying enzyme sphingomyelinase acid phosphodiesterase like 3b (SMPDL3b) in modulating the radiation response in podocytes and glomerular endothelial cells. Hereby, we investigated the interplay between SMPDL3b and oxidative stress in mediating radiation injury in podocytes. We demonstrated that the overexpression of SMPDL3b in cultured podocytes (OE) reduced superoxide anion generation and NADPH oxidase activity compared to wild-type cells (WT) post-irradiation. Furthermore, OE podocytes showed downregulated levels of NOX1 and NOX4 after RT. On the other hand, treatment with the NOX inhibitor GKT improved WTs' survival post-RT and restored SMPDL3b to basal levels. in vivo, the administration of GKT restored glomerular morphology and decreased proteinuria in 26-weeks irradiated mice. Taken together, these results suggest a novel role for NOX-derived reactive oxygen species (ROS) upstream of SMPDL3b in modulating the response of renal podocytes to radiation.

Chimeric antigen receptor T cells immunotherapy: challenges and opportunities in hematological malignancies.

Taking advantage of the cellular immune system is the mainstay of the adoptive cell therapy, to induce recognition and destruction of cancer cells. The impressive demonstration of this principle is chimeric antigen receptor-modified T (CAR-T)-cell therapy, which had a major impact on treating relapsed and refractory hematological malignancies. Despite the great results of the CAR-T-cell therapy, many tumors are still able to avoid immune detection and further elimination, as well as the possible associated adverse events. Herein, we highlighted the recent advances in CAR-T-cell therapy, discussing their applications beneficial functions and side effects in hematological malignancies, illustrating the underlying challenges and opportunities. Furthermore, we provide an overview to overcome different obstacles using potential manufacture and treatment strategies.

Evaluation of interleukin 23 (IL-23) as a non-invasive test of disease severity in patients with ulcerative colitis.

BACKGROUND AND STUDY AIMS: Studies have found increased expression of IL-23 in inflamed and non-inflamed mucosa of patients with ulcerative colitis (UC). We hypothesized that serum interleukin-23 as a non-invasive test has a role in pathogenesis of ulcerative colitis disease and correlates with the disease severity. PATIENTS AND METHODS: Forty patients with biopsy proven ulcerative colitis, recruited from Ain Shams University hospitals were included. Forty healthy subjects matched in age and gender were also included in the study as a control group. Serum IL-23 level was quantified using quantitative ELISA technique (Enzyme linked Immunosorbent Assay). RESULTS: Patients with UC had higher level of interleukin 23 (234.5 ±â€¯161 pg/mL) compared to control subjects (54.2 ±â€¯15 pg/mL) and the level of IL-23 correlated with the disease severity. Cut off value of IL-23 at 68 pg/mL was the best to differentiate between cases and control subjects. Receiver operating characteristic curve (ROC) revealed that the best cut off for IL-23 to detect mild cases of ulcerative colitis was at105 pg/mL, to detect moderate cases at 200 pg/mL and to detect severe cases was at 270 pg/mL with sensitivity 80% to mild cases, 60% to moderate cases and 81% to severe cases. CONCLUSION: Our findings confirm the suggestion that IL-23 level measurement may be of value as a non-invasive test in the diagnosis and disease severity assessment in patients with UC.

Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative.

OBJECTIVES: To determine whether utilization of a hospital-based clinical practice guideline for the care of pediatric iatrogenic opioid dependence (IOD) would promote a decrease in opioid exposure and improve management of opioid abstinence syndrome (AS). METHODS: This study is a retrospective chart review of critically ill patients from a tertiary care children's hospital. Inclusion criteria included mechanically ventilated patients up to 18 years of age who received continuous opioid infusions for at least 7 days and any length of methadone administration. Data on IOD patients from January 2005 to June 2010 was divided into 3 periods: baseline, phase 1, and phase 2. Primary outcome was decrease in opioid exposure, measured by methadone duration of use and any additional opioid bolus doses used in AS management. Documentation of additional opioid bolus doses was regarded as a surrogate measure of AS. Secondary outcomes included total cumulative fentanyl dose, continuous fentanyl infusion duration of use, and hospital and pediatric intensive care unit length of stay. RESULTS: There was a significant decrease in methadone duration of use in IOD patients from 15.3 ± 8.7 days at baseline to 9.5 ± 3.7 days during phase 1 (p = 0.002), to 8.1 ± 3.7 days on phase 2 (reduction not significant, p = 0.106) of this evaluation. Additional opioid bolus doses were significantly lower from baseline to phase 1 (5.5 ± 5.1 vs. 1.8 ± 2.3, p = 0.001) and from phase 1 to phase 2 (1.8 ± 2.3 vs. 0.2 ± 1.5, p = 0.003). For the remaining outcomes, differences were not observed among the evaluation periods, except for the total cumulative fentanyl dose, which was reduced from 2.8 ± 3.7 mg/kg at baseline to 1 ± 1 mg/kg only during phase 1 (p = 0.017). CONCLUSIONS: Introduction of a standardized, hospital-based clinical practice guideline for children with IOD reduced the length of exposure to opioids and improved opioid AS management.

The combined abdominal and perineal approach for dissection of the lower rectum. The development of new indications.

AIMS: Dissection of the lower rectum in some low rectal and pararectal pathologies can be technically difficult that it ends up in abandoning the procedure or raising a permanent stoma. The recently described combined abdomino-perineal approach allows completion of rectal dissection from the perineal route and preservation of the anal sphincters. Patients requiring the combined approach are not seen frequently and reports on this new technique are scarce. The purpose of this study is to analyze our results of using the combined abdomino-perineal approach in different benign and malignant low rectal pathologies, and to describe two new indications for the technique. PATIENTS AND METHODS: This is a retrospective analysis of prospectively collected data of 10 patients (8 males, age range 22-75 years), including 7 cancer patients who required the combined abdomino-perineal approach for completion of their procedures. Previously unreported indications for the technique included iatrogenic rectovaginal fistula and presacral tumor. The study was conducted in a tertiary referral colorectal unit in a university hospital. RESULTS: The procedure was completed and the sphincters preserved in all patients. All cancer patients had adequate resection with good quality mesorectum. Continence was preserved in 4 patients. Three patients are living with permanent stoma. Anastomotic perineal fistula requiring dismantling the anastomosis and raising a permanent stoma occurred in one patient. CONCLUSIONS: The combined abdomino-perineal approach is useful to complete rectal resection in a highly selected group of patients with technically difficult low rectal pathologies. The technique is probably safe in cancer patients and new indications are evolving. Expectations for preservation of continence are disappointing.

Laser-assisted myringotomy versus conventional myringotomy with ventilation tube insertion in treatment of otitis media with effusion: Long-term follow-up.

BACKGROUND: Otitis media with effusion is the most common cause of conductive hearing loss in the pediatric population. Insertion of ventilation tubes with or without adenoidectomy is the accepted and standard surgical procedure. CO2 laser myringotomy without tube placement has been advocated as an alternative treatment. AIM: To compare long-term follow-up results of laser versus classical myringotomy with ventilation tube insertion over five years. MATERIALS AND METHODS: 86 patients with bilateral otitis media with effusion were divided into two groups: laser myringotomy group and myringotomy with ventilation tube insertion group, with follow-up in hearing results and recurrence rates over five years. RESULTS: The mean patency time of myringotomy in laser group was 23 days, while the mean patency time of the ventilation tubes ears was 4.0 months in myringotomy group. Twelve patients in laser group (13.9%) showed a recurrent otitis media with effusion compared to 9 patients in myringotomy group (10.4%). CONCLUSION: Laser fenestration is a less effective alternative to myringotomy and tube placement. The recurrence rates after both procedures did not show statistical significance over long follow-up. It might be considered as an effective alternative to classical surgery and ideal for short-term ventilation.

Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients.

BACKGROUND: Tracheostomy is usually performed in patients with difficult weaning from mechanical ventilation or some catastrophic neurologic insult. Conventional tracheostomy involves dissection of the pretracheal tissues and insertion of the tracheostomy tube into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread acceptance in many intensive care unit and trauma centers. AIM: Aim of the study was to compare percutaneous dilatational tracheostomy versus conventional tracheostomy in intensive care patients. PATIENTS AND METHODS: 64 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; percutaneous dilatational tracheostomy and conventional tracheostomy. RESULTS: Mean duration of the procedure was similar between the two procedures while the mean size of tracheostomy tube was smaller in percutaneous technique. In addition, the Lowest SpO(2) during procedure, PaCO(2) after operation and intra-operative bleeding for both groups were nearly similar without any statistically difference. Postoperative infection after 7 days seen to be statistically lowered and the length of scar tend to be smaller among PDT patients. CONCLUSION: PDT technique is effective and safe as CST with low incidence of post operative complication.

Treatment of clinically diagnosed laryngopharyngeal reflux disease.

OBJECTIVES: To determine the incidence of Helicobacter pylori (HP) stool antigen (HPSA) in patients with laryngopharyngeal reflux disease (LPRD), and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. DESIGN: Randomized controlled study. SETTING: Suez Canal University Hospital, Ismalia, Egypt. PATIENTS: A total of 212 patients with symptoms of LPRD. INTERVENTION: Patients were evaluated by laryngoscopy, ambulatory pH monitoring for 24 hours, and HPSA testing. Esomeprazole magnesium as a monotherapy was evaluated vs triple therapy in patients with HP infection. MAIN OUTCOME MEASURES: To determine the incidence of HPSA in patients with LPRD, and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. RESULTS: Persistent dry cough and a feeling of a lump in the throat (globus sensation) were the most frequent symptoms of LPRD, while posterior laryngeal inflammation was the main laryngoscopic finding. Results from the HPSA test were positive in 57% of the studied group. Patients with negative HPSA were treated with esomeprazole as single modality with a reported improvement score of 96.6%. Patients with positive HPSA test results were divided into 2 groups: 1 received only esomeprazole, with reported improvement in 40%, whereas the second group was treated with esomeprazole, plus amoxicillin sodium and clarithromycin (triple therapy) and reported a 90% incidence of symptom improvement. CONCLUSION: The incidence of HP infection in patients with LPRD in our study was 57%. Triple therapy showed a higher cure rate in patients with HPSA-positive test results.

Utilization of CO(2) laser for temporal fascia graft welding in myringoplasty: an experimental study on guinea pigs.

UNLABELLED: An experimental study was undertaken to investigate the use of a CO(2) laser welding technique in myringoplasty. Albumin solder was used to fix a temporal fascia graft via an overlay transcanal approach. The results of the operative procedure were assessed by microscopic and histopathologic examination over an interval of 1, 2, 3 and 4 weeks postoperatively. MATERIALS AND METHODS: Forty-eight adult guinea pigs were divided into two groups after permanent perforation of the tympanic membrane was created: laser-assisted myringoplasty group and surgical myringoplasty group. Laser beam power was 0.4 W, pulse duration 0.75 s, pulse interval 0.1 s and spot size 250 microm. Each experimental group was further subdivided into four subgroups of 6 animals each. Histological and microscopic findings of the tympanic membrane for both groups after 1, 2, 3, and 4 weeks were compared. RESULTS: Microscopic examination of the tympanic membrane showed high success rate in the laser-assisted myringoplasty group compared to the control group. Histological evaluation for the tympanic membrane showed complete repair of the tympanic membrane in the laser-assisted myringoplasty group. CONCLUSION: Laser-assisted myringoplasty using CO(2) might be a promising new method in surgical myringoplasty.

Evidence for reduced post-spill recovery by the halophyte Sporobolus iocladus (Nees ex Trin.) Nees in oil-contaminated sediments.

The germination behavior of Sporobolus iocladus seeds including germination percentage, accumulated germination percentage, the average incubation period to germination and germination velocity was studied under laboratory conditions. Treatments included six salinity regimes (0, 70, 140, 210, 280 and 350 mM NaCI) and three sources of oil hydrocarbons; Light Arabian Crude, polynuclear aromatic hydrocarbons (PAHs) including diaromatic or triaromatic hydrocarbons (in crude oil equivalent concentrations, COEC). The average incubation period needed for seeds to germinate was significantly longer for seeds germinated in 350 mM NaCl (6 +/- 1.16 days) compared with the control (4 +/- 00 days). The accumulated germination percentage gradually decreased with increasing salinity (control: 90 +/- 10, while 350 mM NaCl: 63 +/- 8.8). Oil hydrocarbons significantly affected all germination parameters of S. iocladus seeds regardless of salinity levels. COEC of di- and triaromatic hydrocarbons suppressed seed germination more than crude oil. Seeds exposed to diaromatic hydrocarbons failed to germinate. Hydrocarbon's salinity interaction significantly reduced the number of germinated S. iocladus seeds. It is concluded that hydrocarbon pollutants adversely affect S. iocladus through reducing germination. It is also suggested that the toxic effect of hydrocarbons on seeds is not solely mediated through their interaction with salinity. The ecological implications of these findings are discussed in relation to other studies on the post-spill recovery of halophytes.

Photosynthetic gas exchange and accumulation of phytotoxins in mangrove seedlings in response to soil physico-chemical characteristics associated with waterlogging.

We evaluated photosynthetic gas exchange and the accumulation of iron, manganese and sulfur in seedlings of five mangrove species (Aegiceras corniculatum (L.) Blanco, Avicennia marina (Forsk.) Vierh., Bruguiera gymnorrhiza (L.) Lamk., Hibiscus tiliaceus L. and Rhizophora stylosa Griff.) growing under anoxic soil conditions at low irradiance. Seedlings of the viviparous mangroves showed no significant responses to root anoxia. The presence of ferrous sulfate or manganous sulfate had a smaller effect on CO(2) assimilation, transpiration rate and stomatal behavior than the presence of sodium sulfide. Sodium sulfide inhibited photosynthetic gas exchange and caused complete stomatal closure in all species. Stomatal closure was probably the result of the damaging effect of sulfide ions on root cell membranes. Some leaf epinasty and wilting were also observed in response to the Na(2)S treatment in all species. A combination of FeSO(4), MnSO(4) and Na(2)S had a smaller effect on photosynthesis than Na(2)S alone, especially for Avicennia marina and Rhizophora stylosa seedlings, which maintained appreciable rates of CO(2) assimilation (2.49 and 3.84 &mgr;mol m(-2) s(-1), respectively) in the presence of all three phytotoxins. Roots of phytotoxin-treated seedlings of all species accumulated significant amounts of the corresponding toxin compared with roots of the control plants. The FeSO(4) or MnSO(4) treatments had no effect on foliar concentrations of iron or manganese, whereas the Na(2)S treatment resulted in an accumulation of S in the leaves of all species. Interactions between Fe(2+) and Mn(2+) and sulfide in the culture medium appeared to reduce their uptake by the seedlings. We conclude that high concentrations of sulfides in mangrove sediments may adversely affect both growth and survival of mangrove seedlings at low irradiances.