Predictive value of S100B and brain derived neurotrophic factor for radiofrequency treatment of lumbar disc prolapse.

BACKGROUND: This work aimed to analyze serum S100B levels and brain-derived neurotrophic factor (BDNF) in patients with lumbar disc prolapse to test their predictive values concerning the therapeutic efficacy of pulsed radiofrequency. METHODS: This prospective interventional study was carried out on 50 patients candidates for radiofrequency for treating symptomatic lumbar disc prolapse. Pain severity and functional disability were assessed using the Numeric Rating Scale (NRS) and Functional rating index (FRI) before as well as two weeks, 1, 3, and 6 months after the radiofrequency. Quantitative assessment of serum S100B level and BDNF was done for all the included patients one day before radiofrequency. RESULTS: The scores of NRS and FRI were significantly improved at two weeks, 1, 3, and 6 months following radiofrequency (P-value < 0.001 in all comparisons). Statistically significant positive correlations were found between duration of pain, NRS, and S100B serum level before radiofrequency, and both NRS (P-value = 0.001, 0.035, < 0.001 respectively) and FRI (P-value = < 0.001, 0.009, 0.001 respectively) 6 months following radiofrequency. Whereas there were statistically significant negative correlations between BDNF serum level before radiofrequency and both NRS and FRI 6 months following radiofrequency (P-value = 0.022, 0.041 respectively). NRS and S100B serum levels before radiofrequency were found to be independent predictors of NRS 6 months following radiofrequency (P-value = 0.040. <0.001, respectively). CONCLUSION: Serum level of S100B is a promising biomarker that can predict functional outcomes after pulsed radiofrequency in patients with lumbar disc prolapse.

Design, Synthesis, and Antiproliferative Activity of Novel Neocryptolepine-Rhodanine Hybrids.

A series of novel neocryptolepine-rhodanine hybrids (9a,b, 11a-d, 14, and 16a,b) have been synthesized by combining neocryptolepine core 5 modified at the C-11 position with rhodanine condensed with the appropriate aryl/hetero aryl aldehydes. Based on these findings, the structures of the hybrids were confirmed by spectral analyses. By employing the MTT assay, all hybrids were tested for their in vitro antiproliferative activity against two cancer cell lines, including MDA-MB-231 (human breast) and HepG-2 (hepatocellular carcinoma). Interestingly, the IC50 values of all hybrids except 9b and 11c showed activity comparable to the standard anticancer drug, 5-fluorouracil, against HepG-2 cancer cells. Furthermore, the cytotoxicity of all the synthesized hybrids was investigated on a normal skin human cell line (BJ-1), and the results showed that these compounds had no significant cytotoxicity toward these healthy cells at the highest concentration used in this study. This study also indicated that the active hybrids exert their cytotoxic activity via the induction of apoptosis. A molecular docking study was used to shed light on the molecular mechanism of their anticancer activity. The docking results revealed that the hybrids exert their mode of action through DNA intercalation. Furthermore, in silico assessment for pharmacokinetic properties was performed on the most potent compounds, which revealed candidates with good bioavailability, high tolerability with cell membranes, and positive drug-likeness values.

Comparison of Three Different Concentrations of Levobupivacaine for Epidural Labor Analgesia: Clinical Effect and Pharmacokinetic Profile.

BACKGROUND: The aim is to compare the clinical effect of three different concentrations of levobupivacaine (0.25%, 0.125%, and 0.0625%) on the sensory and motor block characteristics and mode of delivery during epidural labor analgesia. We also studied the pharmacokinetic profile of the three concentrations during labor. MATERIALS AND METHODS: Sixty pregnant females undergoing normal vaginal delivery under epidural analgesia were divided into three groups according to the concentration of levobupivacaine used. All parturients received an epidural bolus dose of 15 ml of the desired concentration followed by a continuous infusion of the same concentration at 10 mL/h, each combined with fentanyl 2 µg/mL. Sensory block was assessed by the visual analog score (VAS), whereas motor block was evaluated by the Bromage score. Assessments were performed every 5 min in the first 20 min after initiation of epidural analgesia and then at 30 min interval. The incidence of instrumental delivery and cesarean section was also recorded. The total plasma concentrations of levobupivacaine were determined before the start of epidural analgesia, 5 and 10 min after starting the infusion, at infusion stop time, and 3-8 h after infusion termination. RESULTS: The VAS was significantly lower with levobupivacaine concentrations of 0.25% and 0.125% than 0.0625%. Motor block in the form of Bromage score 1 was observed in 39% of parturients receiving levobupivacaine 0.25% of which 43% were converted to cesarean delivery. No motor block was observed with the other two concentrations. Levobupivacaine peak plasma concentrations increased with increasing the concentration of the local anesthetic. There was no difference in other pharmacokinetic parameters between the three groups. CONCLUSION: levobupivacaine concentration of 0.125% is superior to other concentrations for epidural labor analgesia as it provides adequate analgesia without motor affection which reflects in a lower incidence of instrumental delivery or cesarean section.

Effect of omega-3 on hepatic regeneration in adult living donors undergoing hepatic resections for liver transplantation: A randomized controlled trial.

BACKGROUND: Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been shown to improve liver regeneration in experimental models. Aim was to evaluate the effects of ω-3 PUFAs on hepatic regeneration in adult living donors undergoing partial hepatectomy for liver transplantation (LDLT). METHODS: Forty LDLT donors were categorized into 2 groups: received either intravenous ω-3 PUFA-enriched lipid emulsion 20% infusion 7 mL/kg once a day for 2 days before surgery and postoperative day (POD) 0 (S group) or glucose 5% (C group). Hepatic regeneration was assessed by volume of the liver after 1 month using computed tomography, and serial serum levels of hepatocyte growth factor were measured at POD 1, 3, and 5. RESULTS: Liver volume after 1 month was significantly larger in the S group than the C group (1286.75 ± 122.781 cm(3) vs 1169.15 ± 128.3, respectively; P = .00). Both the regeneration index and the regeneration percentage were significantly higher in the S group than the C group (P = .02 and P = .00, respectively). Serum levels of hepatocyte growth factor were significantly higher in the S group on POD 1, 3, and 5 than the C group ([in pg/mL] 188.10 ± 74.25 vs 123.30 ± 13.56, P = .00; 127.55 ± 32.40 vs 109.25 ± 8.89, P = .02; and 109.45 ± 21.44 vs 96.70 ± 5.57, P = .01; respectively). CONCLUSION: Omega-3 polyunsaturated fatty acids effectively promoted liver regeneration and functional recovery following portal hypertension in the setting of LDLT.

Perioperative Calcium, Magnesium, and Phosphorus Levels in Live Donors For Liver Transplant.

OBJECTIVES: The increased number of liver transplants in Egypt has increased the focus on perioperative complications in live donors. An important but not yet well-investigated complication is electrolyte disturbances, which are common in such patients, need intervention, and affect the outcome. We retrospectively analyzed data of perioperative calcium, magnesium, and phosphorus levels in live liver donors at our center. MATERIALS AND METHODS: We collected perioperative laboratory results from 44 living donors for liver transplant who were at our center from February 2009 to August 2013. We analyzed results of perioperative calcium, magnesium, and phosphorus levels before transplant, on the day of transplant (defined as day 0), and at 1 and 2 days after the surgical procedure. RESULTS: Mean serum calcium level was 2.31 mmol/L before transplant, 1.97 mmol/L on day 0, and 1.99 mmol/L on day 1, and 2.05 mmol/L on day 2 after transplant. Serum calcium level was significantly reduced at day 0 and on postoperative days 1 and 2 (P < .0001). Mean magnesium level was 0.8 mmol/L before transplant, 0.58 mmol/L on day 0, and 0.83 mmol/L on day 1, and 0.79 mmol/L on day 2 after the surgical procedure. The day 0 level was significantly reduced versus before transplant (P < .0001). Mean phosphorus level was 1.23 mmol/L before transplant, 1.11 mmol/L on day 0, and 0.97 mmol/L on day 1, and 0.76 mmol/L on day 2 after transplant, with significant declines on day 0 and on postoperative days 1 and 2 (P < .0001). CONCLUSIONS: Living liver donors showed significantly decreased levels of calcium and phosphorus on day 0 and on postoperative days 1 and 2, whereas magnesium level was significantly decreased on day 0 only.

Serum islet cell autoantibodies during interferon alpha treatment in patients with HCV-genotype 4 chronic hepatitis.

Chronic hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease worldwide and HCV genotype 4 (HCV4) is predominant in African and Middle Eastern countries. It is well established that interferon-a (IFNa) treatment for HCV may trigger serum autoantibodies against pancreatic islet cells (ICA) in a subgroup of patients. Available data on the incidence of ICA during IFNa therapy for chronic HCV4 infection are not conclusive. We investigated the appearance of ICA in 40 naïve Egyptian patients (38 males, 32 +/- 6 years) with histologically defined chronic HCV4 infection undergoing IFNa treatment at a dose of 9-million U/week for 24 weeks. Serum samples were collected at baseline and following IFNa therapy and ICA were detected using indirect immunofluorescence. Baseline evaluation indicated that 2/40 (5%) patients had detectable serum ICA. After the completion of the treatment scheme, 12/38 (32%) previously ICA negative patients became ICA positive; however, no patient developed impaired glucose tolerance (IGT) or diabetes during follow-up. In conclusion, we submit that IFNa treatment for chronic hepatitis C (CHC) may induce serum ICA in one-third of Egyptian patients with HCV4. These autoantibodies, however, do not lead to alterations in glucose metabolism.