Effect of mesenchymal stem cells and melatonin on experimentally induced peripheral nerve injury in rats.

Injury of a peripheral nerve (PNI) leads to both ischemic and inflammatory alterations. Sciatic nerve injury (SNI) represents the most widely used model for PNI. Mesenchymal stem cell-based therapy (MSCs) has convenient properties on PNI by stimulating the nerve regeneration. Melatonin has cytoprotective activity. The neuroprotective characteristics of MSCs and melatonin separately or in combination remain a knowledge need. In the rats-challenged SNI, therapeutic roles of intralesional MSCs and intraperitoneal melatonin injections were evaluated by functional assessment of peripheral nerve regeneration by walking track analysis involving sciatic function index (SFI) and two electrophysiological tests, electromyography and nerve conduction velocity, as well as measurement of antioxidant markers in serum, total antioxidant capacity (TAC) and malondialdehyde, and mRNA expression of brain derived neurotrophic factor (BDNF) in nerve tissues in addition to the histopathological evaluation of nerve tissue. Both individual and combination therapy with MSCs and melatonin therapies could effectively ameliorate this SNI and promote its regeneration as evidenced by improving the SFI and two electrophysiological tests and remarkable elevation of TAC with decline in lipid peroxidation and upregulation of BDNF levels. All of these led to functional improvement of the damaged nerve tissues and good recovery of the histopathological sections of sciatic nerve tissues suggesting multifactorial synergistic approach of the concurrent usage of melatonin and MSCs in PNI. The combination regimen has the most synergistic neuro-beneficial effects in PNI that should be used as therapeutic option in patients with PNI to boost their quality of life.

Effective Treatment Methodology for Environmental Safeguard Catalytic Degradation of Fluconazole by Permanganate Ions in Different Acidic Environments: Kinetics, Mechanistics, RSM, and DFT Modeling.

In this paper, the degradation of fluconazole drug (Flz) was explored kinetically utilizing permanganate ion [MnO4-] as an oxidant in different acidic environments, namely sulfuric and perchloric acids at various temperatures. Stoichiometry of the reactions between Flz and [MnO4-] in both acidic environments was attained to be 1.2 ± 0.07 mol. The kinetics of the degradation reactions in both cases were the same, being unit order regarding [MnO4-], fewer than unit orders in [Flz], and fractional second orders in acid concentrations. The rate of oxidative degradation of fluconazole in H2SO4 was higher than that in HClO4 at the same investigational circumstances. The addition of small amounts of Mg2+ and Zn2+ enhanced the degradation rates. The activation quantities were evaluated and debated. The gained oxidation products were characterized using spot tests. A mechanistic approach for the fluconazole degradation was suggested. Finally, the rate law expressions were derived which were agreed with the acquired outcomes. The rates of degradation for various [Flz] were mathematically modeled using the response surface methodology (RSM). The RSM model's conclusions and the experimental findings are in agreement. The oxidative degradation mechanism of Flz using density functional theory (DFT) was performed. The fluconazole drug degrades in acidic settings, protecting both the environment and human health, according to a method that is easy to use, powerful, inexpensive, practical, affordable, and safe.

Two-dimensional speckle tracking echocardiography in chemotherapy-induced cardiotoxicity in females with breast cancer.

BACKGROUND: Cancer and cardiovascular diseases are the main causes of mortality worldwide. Although the incidence of cancer is rising, modern comprehensive management including surgery, chemotherapy, and radiotherapy led to decreased mortality, but also different cardiovascular complications. Conventional EF measurement fails to detect subtle changes in LV function, so a more sensitive tool is needed. METHODS: The study included 101 asymptomatic female patients with newly diagnosed breast cancer who received anthracycline ± trastuzumab-based chemotherapy regimen. A comprehensive echocardiographic examination was performed before receiving the chemotherapy (T0), at 3 months (T1), and at 6 months after (T2). All patients had pre-treatment normal LV EF. Asymptomatic CTRCD is defined as: severe if new LVEF reduction to < 40%, moderate if new LVEF reduction by ≥ 10 percentage points to an LVEF of 40-49% or new LVEF reduction by, 10 percentage points to an LVEF of 40- 49% and either new relative decline in GLS by .15% from baseline or new rise in cardiac biomarkers and mild if LVEF ≥ 50% and new relative decline in GLS by .15% from baseline and/or new rise in cardiac biomarkers. Symptomatic CTRCD is defined as: very severe if HF requiring inotropic support, mechanical circulatory support, or consideration of transplantation, severe if required hospitalization, moderate if required outpatient intensification of diuretic and HF therapy and mild if there are mild HF symptoms and no intensification of therapy required according to the latest ESC cardio oncology guidelines. The Lower reference value set for RV S' was less than 10cm/s to define RV systolic dysfunction according to ASE guidelines. RESULTS: CTRCD occurred in 24 patients (25.5%) while RV systolic dysfunction was more common occurring in 37 patients (39.4%). LV GLS at (T1) (cut-off value < -15% with relative 12.5% reduction from the baseline value) was a strong predictor of CTRCD, but combining LV GLS with RV GLS & RV FWLS was the strongest (AUC = 0.947, sensitivity = 91.67%, specificity = 90%). CONCLUSION: Chemotherapy induces biventricular changes with more prevalent deterioration in RV values. Low LV & RV strain values at baseline together with reduction of these values after chemotherapy treatment can predict later CTRCD development. Combining LV GLS with RV GLS & FWLS values at (T1) is the strongest predictor of subsequent CTRCD.

Effect of Adsorption and Interactions of New Triazole-Thione-Schiff Bases on the Corrosion Rate of Carbon Steel in 1 M HCl Solution: Theoretical and Experimental Evaluation.

Due to the unique properties of steel, including its hardness, durability, and superconductivity, which make it an essential material in many industries, it lacks corrosion resistance. Herewith, two novel triazole-thione Schiff bases, namely, (E)-5-methyl-4-((thiophen-2-ylmethylene)amino)-2,4-dihydro-3H-1,2,4-triazole-3-thione (TMAT) and (E)-4-(((5-(dimethylamino)thiophen-2-yl)methylene)amino)-5-methyl-2,4-dihydro-3H-1,2,4-triazole-3-thione (DMTMAT), were synthesized and characterized. The corrosion inhibition (CI) ability of these two molecules on carbon steel in an aqueous solution of 1 M HCl as well as their interaction with its surface was studied using a number of different techniques. The results confirmed that the CI capability of these organic molecules depends on their strong adsorption on the metal surface and the formation of a protective anticorrosion film. Weight loss tests revealed that the inhibition efficiencies of TMAT and DMTMAT were 91.1 and 94.0%, respectively, at 1 × 10-3 M concentrations. The results of electrochemical impedance spectroscopy (EIS) indicated that there was a direct relationship between the inhibitor concentration and the transfer resistance. Potentiodynamic polarization (PDP) experiments have proven to be mixed-type inhibitors of C-steel in aqueous hydrochloric acid solution and follow the Langmuir adsorption isotherm model. Several thermodynamic and kinetic parameters were calculated. The negative values of the adsorption-free energy are -36.7 and -38.5 kJ/mol for TMAT and DMTMAT, respectively, confirming the spontaneity of the adsorption process. The MD simulation study's findings show that the inhibitor molecules are nearly parallel to the metal surface. The interaction energy calculated by the MD simulation and the inhibitory trend are the same. The practical implementation is consistent with what the computer models predicted.

Reconstruction of Upper Third Defect of the Auricle by Conchal Cartilage Graft and Coverage by Postauricular Flap.

BACKGROUND: The defects of the upper third of the auricle are considered significant reconstructive challenges, as they require frequent operations with a high risk of morbidity at the donor site and result in unacceptable cosmetic abnormalities. OBJECTIVE: Is to perform the reconstruction of a full-thickness auricular defect located in the upper third of the ear using a conchal cartilage graft with postauricular flap coverage, aiming to minimize both donor and recipient morbidity. PATIENTS AND METHODS: The current study included 20 patients with unilateral upper-third auricular defects. The repair involved 2 components: a cartilage graft from the concha to provide structural support and a flap for coverage. Follow-up was conducted for 6 months after the operation. RESULTS: Successful outcomes were achieved in both subjective and doctors' assessments. Regarding subjective outcomes, 85% of the patients reported high satisfaction (P < .001). In terms of doctors' subjective assessment, 90% of the patients had excellent results (P < .001). Mild early and postoperative complications, if encountered, resolved spontaneously. CONCLUSION: The use of a combined conchal cartilage graft and postauricular flap in treating a full-thickness upper third auricular defect is safe and effective, with no major complications. The technique preserves the cosmetic and functional outcomes of the auricle, providing an excellent color match and minimal donor-site morbidity.

Dyslipidemia initiates keratinocytes proliferation through upregulation of lncRNA NEAT in psoriasis patients.

BACKGROUND: Psoriasis is a chronic inflammatory immune-mediated and hyper proliferative skin disorder that has underlying genetic factors. Psoriasis can result from interaction of cytokines between keratinocytes and T-lymphocytes. NEAT is a lncRNA involved in immune modulation and has been previously studied in cancers. This study aims to clarify the unprecedented role of NEAT in psoriasis pathogenesis. METHODS: The study was conducted on 50 healthy control subjects and 50 psoriasis patients. Blood samples from all participants were collected for analysis of their lipid profile. qRT-PCR was done for lncRNA NEAT, TNF-α, VEGF genes expression. The levels of ROS and caspase-3 were estimated by ELISA. ROC analysis was done to detect the diagnostic value of lncRNA NEAT gene expression. RESULTS: Dyslipidemia is more prevalent among psoriasis patients. A significant up regulation in lncRNA NEAT, TNF-α, VEGF genes expression (p value˂0.001) in psoriasis patients in addition to significant increase in ROS and caspase-3 levels (p value˂0.001) in compare to controls. Additionally, a positive significant correlation between TNF-α, ROS, NEAT, caspase-3 and dyslipidemia. NEAT had an area under the curve (AUC) of 0.931 (95% CI 0.844-0.978, p < 0.001). CONCLUSION: Dyslipidemia is an initiating signal in psoriasis pathogenesis that creates a state of chronic inflammation and oxidative stress. This state induces keratinocytes proliferation and release of NEAT with subsequent caspase-3 activation to counteract the proliferating cells. NEAT could be considered as a good diagnostic biomarker for psoriasis.

Non-surgical Root Canal Treatment of an Upper First Molar With an Unusual Morphology: A Case Report.

This paper presents the unusual morphology of an upper right first molar with two roots, each containing a single canal, in a patient seeking emergency endodontic treatment. Clinical and radiographic examinations revealed the unusual root canal morphology of the tooth, which required further investigation using cone beam computed tomography (CBCT) imaging, which confirmed this unusual anatomical structure. It was also noted that the upper right first molar was asymmetrical to the upper left first molar, which had the normal three-root morphology. The buccal and palatal canals were instrumented using ProTaper Next Ni-Ti rotary instruments and enlarged to ISO size 30, with a taper of 0.7; irrigated with 2.5% NaOCl; filled with gutta-percha using the warm-vertical-compaction technique, with the aid of a dental operating microscope (DOM); and then confirmed via periapical radiograph. The DOM and CBCT are valuable aids that helped us to confirm the endodontic diagnosis and treatment of this unusual morphology.

Unraveling the Adsorption Mechanism and Anti-Corrosion Functionality of Dextrin and Inulin as Eco-Friendly Biopolymers for the Corrosion of Reinforced Steel in 1.0 M HCl: A Thermodynamic and Kinetic Approach.

Reinforcing steel (RS) is mainly used in building construction and many industries, but it suffers from corrosion problems, especially in acidic environments. Biopolymers are characterized by their unique chemical composition, as they contain a variety of functional groups that are capable of binding strongly to the metal surface and forming a protective layer on it. Herewith, two biopolymers, viz. dextrin (Dex) and inulin (Inu), were tested as eco-friendly inhibitors for the corrosion of RS in 1.0 M HCl medium at different temperatures. Various experimental tools were utilized in this research. The inhibition efficiencies (% IEs) of the tested polymeric compounds were improved by increasing their doses while reducing with rising temperature. The % IEs of Dex and Inu at a dose of 500 mg/L reached 85% and 93%, respectively. The examined biopolymers displayed cathodic/anodic behavior (mixed type) with a foremost anodic one. The acquired higher % IEs were demonstrated by intense adsorption of Dex and Inu on the RS surface fitting the Langmuir isotherm. The influence of rising temperature in the range of 288-318 K on the corrosion behavior was examined, and the evaluated thermodynamic and kinetic parameters sustained the mechanism of physical adsorption of the polymeric inhibitors. Additionally, the kinetics of corrosion, as well as its inhibition by Dex and Inu, were also investigated. The SEM micrographs of the RS surfaces were accorded with all utilized experimental tools. The results gained from all used tools were discovered to be in good agreement with each other.

Hibiscus attenuates renovascular hypertension-induced aortic remodeling dose dependently: the oxidative stress role and Ang II/cyclophilin A/ERK1/2 signaling.

Introduction: The high levels of angiotensin II (Ang II) can modify the vascular tone, enhance vascular smooth muscle cells (VSMCs) proliferation and hypertrophy and increase the inflammatory cellular infiltration into the vessel wall. The old herbal nonpharmacological agent, Hibiscus (HS) sabdariffa L has multiple cardioprotective impacts; thus, we investigated the role of HS extract in amelioration of renovascular hypertension (RVH)-induced aortic remodeling. Materials and methods: Thirty-five rats (7/group) were randomly allocated into 5 groups; group: I: Control-sham group, and RVH groups; II, III, IV, and V. The rats in RVH groups were subjected to the modified Goldblatt two-kidneys, one clip (2K1C) for induction of hypertension. In group: II, the rats were left untreated whereas in group III, IV, and V: RVH-rats were treated for 6 weeks with low dose hibiscus (LDH), medium dose hibiscus (MDH), and high dose hibiscus (HDH) respectively. Results: We found that the augmented pro-contractile response of the aortic rings was ameliorated secondary to the in-vivo treatment with HS dose dependently. The cyclophilin A (CyPA) protein levels positively correlated with the vascular adhesion molecule-1 (VCAM-1) and ERK1/2, which, in turn, contribute to the reactive oxygen species (ROS) production. Daily HS intake modified aortic renovation by enhancing the antioxidant capacity, restraining hypertrophy and fibrosis, downregulation of the metastasis associated lung adenocarcinoma transcript (MALAT1), and cyclophilin A (CyPA)/ERK1/2 levels. Discussion: Adding to the multiple beneficial effects, HS aqueous extract was able to inhibit vascular smooth muscle cell proliferation induced by 2K1C model. Thus, adding more privilege for the utilization of the traditional herbal extracts to attenuate RVH-induced aortopathy.

Evaluation of functional and aesthetic outcomes of free dermal fat graft versus superficial musculoaponeurotic system flap after superficial parotidectomy: randomized clinical trial.

BACKGROUND: Parotidectomy is the standard procedure for treatment of many parotid lesions; however, it has several drawbacks. Facial asymmetry and Frey's syndrome are the most annoying complications to patients. Insertion of interpositioning grafts into the parotidectomy bed can decrease these complications significantly. Free dermal fat graft (FDFG) and superficial musculoaponeurotic system (SMAS) flap have very promising results. This RCT aimed to compare these two techniques regarding functional and aesthetic outcomes. METHODS: Between February 2016 and October 2021, adult patients undergoing superficial conservative parotidectomy in a single centre for a benign indication were randomized into two equal groups using a closed envelope method. In one group, FDFG was inserted at the parotidectomy bed, whereas, in the other group, SMAS flap was performed. Preoperative, operative, and postoperative data were recorded and analysed. The primary outcome was the development of Frey's syndrome. RESULTS: Seventy-eight patients were randomized into two equal groups of 39 patients. There was no significant difference between the two groups regarding development of Frey's syndrome. There was no significant statistical difference between study groups regarding demographic data, co-morbidities, parotid pathologies, specimen volumes, total operating time, and postoperative complications. A tendency for over correction was observed in FDFG and under correction in SMAS flap. There was no statistically significant difference between the study groups regarding the patients' aesthetic satisfaction with the majority displaying excellent satisfaction with no poor results. CONCLUSION: FDFG and SMAS flap are simple, rapid, and reliable procedures and are effective in improving both functional and aesthetic outcomes post-parotidectomy. They have comparable results; however, selection of either procedure can be determined according to patient and tumour characteristics. Registration number: NCT05452837 (http://www.clinicaltrials.gov).

Experimental and Computational Exploration of Chitin, Pectin, and Amylopectin Polymers as Efficient Eco-Friendly Corrosion Inhibitors for Mild Steel in an Acidic Environment: Kinetic, Thermodynamic, and Mechanistic Aspects.

Herein, the inhibition impacts of chitin, pectin, and amylopectin as carbohydrate polymers on the corrosion of mild steel in 0.5 M HCl were researched utilizing various experimental and theoretical tools. The acquired outcomes showed that the inhibition efficiencies (% IEs) of the tested carbohydrate polymers were increased by raising their concentrations and these biopolymers acting as mixed-kind inhibitors with major anodic ones. The acquired % IEs values were reduced with rising temperature. The higher % IEs of the tested polymers were inferred via powerful adsorption of the polymeric molecules on the steel surface and such adsorption obeyed the Langmuir isotherm. The computed thermodynamic and kinetic quantities confirmed the mechanism of physical adsorption. The kinetics and mechanisms of corrosion and its protection by polymeric compounds were illuminated. The results obtained from all the techniques used confirmed that there was good agreement with each other, and that the % of IEs followed the sequence: chitin > amylopectin > pectin.

Evaluation of synthesized biosurfactants as promising corrosion inhibitors and alternative antibacterial and antidermatophytes agents.

This study investigated different amino acid-based surfactants (AASs), also known as biosurfactants, including sodium N-dodecyl asparagine (AS), sodium N-dodecyl tryptophan (TS), and sodium N-dodecyl histidine (HS) for their potential anticorrosion, antibacterial, and antidermatophyte properties. The chemical and electrochemical techniques were employed to examine the copper corrosion inhibition efficacy in H2SO4 (1.0 M) solution at 298 K. The results indicated their promising corrosion inhibition efficiencies (% IEs), which varied with the biosurfactant structures and concentrations, and the concentrations of corrosive medium. Higher % IEs values were attributed to the surfactant adsorption on the copper surface and the production of a protective film. The adsorption was in agreement with Langmuir adsorption isotherm. The kinetics and mechanisms of copper corrosion and its inhibition by the examined AASs were illuminated. The surfactants behaved as mixed-kind inhibitors with minor anodic priority. The values of % IEs gained from weight loss technique at a 500 ppm of the tested surfactants were set to be 81, 83 and 88 for AS, HS and TS, respectively. The values of % IEs acquired from all the applied techniques were almost consistent which were increased in the order: TS > HS ≥ AS, establishing the validity of this study. These surfactants also exhibited strong broad-spectrum activities against pathogenic Gram-negative and Gram-positive bacteria and dermatophytes. HS exhibited the highest antimicrobial activity followed by TS, and AS. The sensitivity of pathogenic bacteria varied against tested AASs. Shigella dysenteriae and Trichophyton mantigrophytes were found to be the most sensitive pathogens. HS exhibited the highest antibacterial activity against Shigella dysenteriae, Bacillus cereus, E. coli, K. pneumoniae, and S. aureus through the formation of clear zones of 70, 50, 40, 39, and 35 mm diameters, respectively. AASs also exhibited strong antifungal activity against all the tested dermatophyte molds and fungi. HS caused the inhibition zones of 62, 57, 56, 48, and 36 mm diameters against Trichophyton mantigrophytes, Trichophyton rubrum, Candida albicans, Trichosporon cataneum, and Cryptococcus neoformans, respectively. AASs minimal lethal concentrations ranged between 16 to 128 µg/ml. HS presented the lowest value (16 µg/ml) against tested pathogens followed by TS (64 µg/ml), and AS (128 µg/ml). Therefore, AASs, especially HS, could serve as an effective alternative antimicrobial agent against food-borne pathogenic bacteria and skin infections-associated dermatophyte fungi.

Vitamin D and miRNA-155 in Behçet's Disease: Possible Association with the Disease and Disease Activity.

Background: Vitamin D (vit D) controls inflammation and immunity. In Behçet's disease (BD), microRNA-155 is recognized as a significant immune response regulator. We aimed to investigate the role of vit D on immunomodulation and downregulation of inflammatory pathways associated with BD and detect the role of miRNA-155 in BD. Methods: miRNA-155 expression by Real Time -Polymerase Chain Reaction (RT-PCR), and vit D, nuclear factor Kappa-light-chain-enhancer of activated B cells (NF-κB), and Tumor necrosis fact of TNF-α) expression by Enzyme Linked Immunosorbent Assay (ELISA) were assessed. Results: BD patients had a significantly higher relative expression of microRNA-155 (P< 0.001), it was significantly related to vascular manifestations (P< 0.001). Vit D relative expression was significantly low in BD (P< 0.001). There was a significant rise in miRNA-155 in the active group compared to the inactive group (P< 0.001). A significant decrease in vit D levels (IU) was found in inactive and active individuals suffering from BD when compared to controls (P< 0.001). A significant rise was found in vit D levels in inactive BD cases (P< 0.001). A significant positive correlations were found between miRNA-155, NF-κB, TNF-α, and negative correlations with vit D relative expression in BD patients. Conclusions: miRNA-155 relative expression is higher in BD is significantly related to vascular manifestations. It may have a relationship to disease activity. Vitamin D relative expression is significantly low in BD patients, which can significantly influence immunomodulatory BD therapy. Vitamin D deficiency linked to active BD.

Computational Foretelling and Experimental Implementation of the Performance of Polyacrylic Acid and Polyacrylamide Polymers as Eco-Friendly Corrosion Inhibitors for Copper in Nitric Acid.

Copper is primarily used in many industrial processes, but like many other metals, it suffers from corrosion damage. Polymers are not only one of the effective corrosion inhibitors but also are environmentally friendly agents in doing so. Hence, in this paper, the efficacy of two polyelectrolyte polymers, namely poly(acrylic acid) (PAA) and polyacrylamide (PAM), as corrosion inhibitors for copper in molar nitric acid medium was explored. Chemical, electrochemical, and microscopic tools were employed in this investigation. The weight-loss study revealed that the computed inhibition efficiencies (% IEs) of both PAA and PAM increased with their concentrations but diminished with increasing HNO3 concentration and temperature. The results revealed that, at similar concentrations, the values of % IEs of PAM are slightly higher than those recorded for PAA, where these values at 298 K reached 88% and 84% in the presence of a 250 mg/L of PAM and PAA, respectively. The prominent IE% values for the tested polymers are due to their strong adsorption on the Cu surface and follow the Langmuir adsorption isoform. Thermodynamic and kinetic parameters were also calculated and discussed. The kinetics of corrosion inhibition by PAA and PAM showed a negative first-order process. The results showed also that the used polymers played as mixed-kind inhibitors with anodic priority. The mechanisms of copper corrosion in nitric acid medium and its inhibition by the tested polymers were discussed. DFT calculations and molecular dynamic (MD) modelling were used to investigate the effect of PAA and PAM molecular configuration on their anti-corrosion behavior. The results indicated that the experimental and computational study are highly consistent.

Inflammatory biomarkers and severity of COVID-19: Cross sectional study among Egyptian patients.

The newly emerging coronavirus disease 2019 (COVID-19) is characterized by multisystem inflammatory syndrome. The development of SARS-CoV-2 complications usually starts within few days following infection, and the severity of the disease determines its outcome. Vitamin D insufficiency is associated with risk of lung infections, also cell-based studies reported the ability of vitamin D to control enveloped virus growth. We aimed to investigate the relationship between the most eminent inflammatory biomarkers and the level of vitamin D aiming to provide a tool for early diagnosis and prediction of disease progression. The current study was approved by Research Ethics Committee (REC), Kasr Al-Ainy. After confirmation of being COVID-19 by PCR, the admitted patients were categorized as mild-moderate, and severe-critically ill based on clinical and radiologic data. The total levels of serum 25(OH)D, as well as other pro-inflammatory biomarkers were measured and were analyzed by receiver operating characteristic curve (ROC) analysis for detection of their association with COVID-19 disease severity and to determine their sensitivity and specificity at optimum cutoff points. The area under the curve (AUC) ROC for predicting COVID-19 disease severity was the highest (of 0.97) for vitamin D, inflammatory cytokines, liver enzymes, ferritin, and D-Dimer. In addition, high serum levels of creatinine, and elevated liver enzymes associated with severe-critical COVID-19. The low 25(OH)D was associated with the disease severity.

Transperitoneal laparoscopic simple nephrectomy for giant hydronephrosis: Tips and tricks to make it easier.

PURPOSE: We report our experience with transperitoneal laparoscopic nephrectomy (LN) for giant hydronephrosis (GH) and compare the outcome data with open nephrectomy (ON). PATIENTS AND METHODS: The retrospective data of 88 patients (52 males and 36 females) who underwent LN or ON for treatment of GH in the period between October 2015 and December 2019 were investigated. LN was performed in 38 patients, while 50 patients underwent ON. We compared the two groups for success, operative time, and intraoperative and postoperative complications. RESULTS: The mean age of the patients in the LN group was 45.8 ± 11.4 years, and it was 44.7 ± 10.8 years in the ON group. The mean operative time in the LN group was statistically significantly longer when compared with the ON group195 ± 18 min versus 127 ± 22 min (p = 0.01).The estimated blood loss was significantly greater in the ON group (p = 0.01). However, no patients required blood transfusions in either group. The visual analog pain (VAP) scores were significantly higher on both day 1 and day 2 in the ON group 3.6 ± 0.9 and 2 ± 0.7 versus 2.7 ± 0.6 and 1.4 ± 0.5 in LN group, (p = 0.01). CONCLUSION: LN for GH is feasible, safe, and efficacious. Compared to open surgery, the laparoscopic approach resulted in significantly shorter hospital stays, decreased morbidity, and quicker recovery. Some tips and tricks could help to do it in an easier way and reduce the operative time.

Cardiac Catheterization During Extracorporeal Membrane Oxygenation After Congenital Cardiac Surgery: A Multi-Center Retrospective Study.

Cardiac catheterization can affect clinical outcomes in patients on extracorporeal membrane oxygenation (ECMO) after congenital heart surgery; however, its effect in this group of patients remains unclear. This study aimed to evaluate the safety and outcome of cardiac catheterization in patients undergoing ECMO after congenital cardiac surgery and determine predictors that influence successful weaning. This retrospective cohort study included pediatric patients who underwent cardiac catheterization while on ECMO after congenital heart surgery in two cardiac centers between November 2012 and February 2020. Predictors of successful weaning from ECMO were studied using univariate and multivariate logistic regression analyses. Of 123 patients on ECMO support after congenital cardiac surgery, 60 patients underwent 60 cardiac catheterizations (31 diagnostic and 29 interventional). Thirty-four (56.7%) and 22 patients (36.7%) underwent successful decannulation from ECMO support and survived after hospital discharge, respectively. Patients who underwent earlier catheterization (within 24 h of ECMO initiation) had more successful weaning from ECMO and survival compared to others. Patients who underwent an interventional procedure (interventional catheterization or redo cardiac surgery after cardiac catheterization) had better survival than those who underwent only diagnostic catheterization (P = 0.038). Shorter durations of ECMO was the most important predictor of successful weaning from ECMO. Early cardiac catheterization greatly impacts successful weaning from ECMO and survival. Patients with correctable lesions amenable either by catheterization or redo surgery are more likely to survive. Shorter durations of ECMO could have a significant influence on successful weaning from ECMO and survival.

Role for fibrin glue (sealant) in seroma reduction after inguinal lymphadenectomy; a randomized controlled trial.

BACKGROUND: Seroma is one of the most commonly encountered morbidities after inguinal lymph node dissection (ILND). It causes much nuisance to both patients and doctors and its presence can lead to many complications. This study aimed to evaluate the role and impact of using fibrin glue to decrease seroma formation in patients undergoing ILND. MATERIALS AND METHODS: Thirty-two patients underwent ILND for various reasons. The patients were randomly divided into two groups; 16 in each group. In one group, fibrin glue sealant was applied with a dosage of 2 ml per 100 cm2 surface area. Drain placement was then performed. In the control group, only drain placement was used. Preoperative, operative and postoperative data were recorded and analyzed. RESULTS: There was a significant reduction in the incidence of seroma formation favoring the fibrin glue group when compared to the control group (P = 0.022). There was also a significant reduction of total cumulative amount of serous fluid (P < 0.001), time to remove drains (P < 0.001), and hospital stay (P = 0.012). There was no significant difference between the two groups in occurrences of hematoma, infection or superficial skin edge necrosis. CONCLUSION: Fibrin glue sealant has a role to play in ILND as it significantly reduced the incidence of seroma formation. Standardization of definition of seroma as well as dosage and technique of fibrin glue have to be reached in future studies to determine the true role of fibrin glue in ILND.

Differential molecular and hormonal changes in oocytes, granulosa cells and follicular fluid of pregnant and non-pregnant camels.

This study aimed to compare the expression of genes regulating follicles development, survival and steroid hormones secretion in oocytes and granulosa cells (GCs) and study the correlation between their expression and follicular fluid (FF) levels of progesterone (P4) in pregnant and non-pregnant camels. In total, 138 ovarian pairs from slaughtered camels were used. Gene expression and hormonal assay were determined using real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. The obtained results revealed that the number of follicles (3-8 mm) was significantly (P < 0.05) lower in pregnant, compared with non-pregnant, camels. P4 level in the FF was significantly (P < 0.05) higher in pregnant, compared with non-pregnant, camels. However, no significant (P > 0.05) difference was noticed in the oestradiol (E2) level. STAR, PTEN, IGF1 and BCL2 mRNA levels were significantly higher in GCs and significantly lower in oocytes of pregnant, compared with non-pregnant, camels. However, follicle-stimulating hormone receptor (FSHR) mRNA level was significantly lower in GCs and oocytes, and the BMP15 mRNA level was significantly lower in oocytes of pregnant, compared with non-pregnant, camels. P4 level in FF was positively correlated with STAR, PTEN, IGF1 and BCL2 mRNA levels in GCs and negatively correlated with BMP15 mRNA levels in oocytes and FSHR mRNA levels in GCs and oocytes of pregnant camels. It could be concluded that pregnancy-induced variations in oocytes and GC expression of BMP15, IGF1, FSHR, STAR, BCL2, and PTEN genes might be associated with a decrease in the number of follicles and an increase in the FF level of P4.

Contralateral Coupling During Extracorporeal Shockwave Lithotripsy for Stones in Ectopic Kidney: Is It Feasible?

Purpose: Extracorporeal shockwave lithotripsy (SWL) results in a lower stone-free rate (SFR) for ectopic kidneys when using the standard technique, directing the shock wave from the same side of the stone; however, this may not be the optimal approach when the ectopic kidney is located more medial and anterior than the normally positioned kidney. Thus, contralateral coupling where waves come from the opposite direction may result in a better outcome. We tested the feasibility and outcome of contralateral coupling during SWL for stone in ectopic kidney. Materials and Methods: We prospectively recruited 20 patients with simple renal ectopia, who presented with renal stones that were amenable for SWL in the period between 2014 and 2018 at outpatient clinic of urology department, Minia University. Patients received SWL in Private Nile SWL Center were included to benefit from the ability of the electromagnetic SWL lithotripter. We did SWL in a supine position, and then contralateral coupling was performed from the opposite side of the affected kidney, rather than using the standard ipsilateral coupling approach. The SFR and various pre-, intra-, and postprocedural SWL variables were assessed, including stone characteristics, body habitus, shock wave numbers, and auxiliary measures. Count and percentages were calculated. Results: The mean stone radius was 14.7 mm with a mean S.T.O.N.E. (size, topography, obstructions, number of stones, and evaluation of HUs) of 9.6 points. Effective SWL was achieved in 80% of cases, 65% of them were stone free with effective single SWL session in 56% of cases. Hematuria, infection, and obstruction occurred in 50%, 20%, and 15% cases, respectively. One case required ureteral stent insertion. Conclusions: SWL applied through contralateral coupling is feasible, with comparable safety profile to the standard ipsilateral approach. Better SFR was achieved with the contralateral approach, in fewer sessions. However, the recruitment of more cases is necessary.