Elevated expression patterns of P-element Induced Wimpy Testis (PIWI) transcripts are potential candidate markers for Hepatocellular Carcinoma.

BACKGROUND: P-Element-induced wimpy testis (PIWI) proteins, when in combination with PIWI-interacting RNA (piRNA), are engaged in the epigenetic regulation of gene expression in germline cells. Different types of tumour cells have been found to exhibit abnormal expression of piRNA, PIWIL-mRNAs, and proteins. We aimed to determine the mRNA expression profiles of PIWIL1, PIWIL2, PIWIL3, & PIWIL4, in hepatocellular carcinoma patients, and to associate their expression patterns with clinicopathological features. METHODS: The expression patterns of PIWIL1, PIWIL2, PIWIL3, PIWIL4 mRNA, was assessed via real-time quantitative polymerase chain reaction (RT-QPCR), on tissue and serum samples from HCC patients, their impact for diagnosis was evaluated by ROC curves, prognostic utility was determined, and In Silico analysis was conducted for predicted variant detection, association with HCC microRNAs and Network Analysis. RESULTS: Expression levels were significantly higher in both HCC tissue and serum samples than in their respective controls (p< 0.001). Additionally, the diagnostic performance was assessed, Risk determination was found to be statistically significant. CONCLUSION: PIWIL mRNAs are overexpressed in HCC tissue and serum samples, the expression patterns could be valuable molecular markers for HCC, due to their association with age, tumour grade and pattern. To the best of our knowledge, our study is the first to report the expression levels of all PIWIL mRNA and to suggest their remarkable values as diagnostic and prognostic biomarkers, in addition to their correlation to HCC development. Additionally, a therapeutic opportunity might be also suggested through in silico miRNA prediction for HCC and PIWIL genes through DDX4 and miR-124-3p.

Comparison Between Pre-operative Radiologic Findings and the Actual Operative Findings of the Graft in Adult Living Donor Liver Transplantation.

BACKGROUND: Computed tomography (CT) volumetry and magnetic resonance cholangiopancreatography (MRCP) are mandatory steps for the evaluation of potential donors in living donor liver transplantation. The aim of this study is to compare the preoperative CT volumetry and biliary orifices of the donor graft to the actual operative findings. METHODS: Between December 2013 and December 2017, 45 donors (27 men and 18 women) with a mean age of 27.3 years (range, 19-41 years) were evaluated preoperatively by CT volumetry and MRCP at the National Hepatology and Tropical Medicine Research Institute in Cairo, Egypt. Of the donors, 43 out of 45 underwent intraoperative cholangiography before and after bile duct division. The right hepatectomies for all donors, as well as the actual weight and apparent biliary orifices in the graft, were documented. RESULTS: The mean estimated graft volume (EGV) preoperatively by CT volumetry was 894.9 ± 184.2 mL (range, 480-1687 mL), whereas the actual graft weight (AGW) intraoperatively after washout was 862.6 ± 124.4 g (range, 676-1110 g). The correlation coefficient between the EGV and AGW was significantly linear (Y = 0.96X, r2 = 0.72, slope: 0.96, P < .001). The accuracy of the MRCP in preoperative biliary mapping was 76.7% whereas the accuracy of the MRCP in predicting the number of graft biliary orifices was 74.4% compared with the intraoperative cholangiography (IOC), which was 95.3% (P < .001). CONCLUSION: The weight of the right lobe of the liver graft in living donor liver transplants (LDLTs) can be accurately predicted preoperatively by multiplying the EGV by 0.96. Also, the IOC is an essential technique for LDLT.

Impact of pre-transplant infection management on the outcome of living-donor liver transplantation in Egypt.

BACKGROUND AND AIM: Liver transplantation (LT) has emerged as an established therapeutic option for patients with chronic liver disease. Patients with end-stage liver disease are at high risk of infection with multidrug-resistant organisms, which may affect the outcome of LT. The aim of this study was to evaluate the impact of pre-transplant infection on the outcome of living-donor LT. METHODS: Prospective follow-up was done for 50 patients with chronic liver disease who had had LT performed from September 2013 to December 2017. We divided patients into group 1 (patients who had had infection within 3 months before transplantation with adequate treatment [n=20]), and group 2 (patients without infection [n=30]). Both groups were followed for 4 months post-operatively. RESULTS: Patients with high Model for End-Stage Liver Disease scores were more susceptible to infection pre- and post-operatively, and chest infection was the most common infection pre-transplant. There were no significant statistical differences regarding hospital and ICU stay and post-operative course between the groups, but the mortality rate was higher in group 1 (40%) than in group 2 (23.3%), and the causes of mortality in the group 1 were mainly due to medical causes (infections and sepsis, 75%) versus 28.6% in group 2. CONCLUSION: Liver-cell failure and concomitant infection 3 months before LT with adequate treatment had no significant statistical differences regarding hospital, ICU stay, or medical complications, but post-operative infection and mortality rate were more frequent in group 1 and the causes of mortality were mainly medical.

Laparoscopic Radiofrequency Thermal Ablation of Hepatocellular Carcinoma in Liver Cirrhosis Patients.

BACKGROUND: Laparoscopic radiofrequency ablation (LRFA) for hepatocellular carcinoma (HCC) under guidance of intra-operative laparoscopic ultrasound (IOLUS) aiming of obtaining additional information for liver situation, better tumor staging and effective treatment of hepatic focal lesion (HFL) in patients with a difficult percutaneous approach. METHODS: Between September 2010 and July 2012, 301 patients with HCC in liver cirrhosis were referred from HCC clinic at National Hepatology and Tropical Medicine Research Institute (NHTMRI). Twenty nine patients were submitted to LRFA with IOLUS guidance. Operation time, hospital stay, post procedure complication were recorded. Spiral CT scan one month postoperative was mandatory during follow up. RESULTS: LRFA was completed in all patients. The IOLUS examination identified new HFL in three patients. A total of 32 lesions were treated. The mean operative time was 120 minutes; eight procedures were associated in six patients: cholecystectomy (6) and adhesiolysis (2). A complete tumor ablation was observed in all patients which were documented via spiral computed tomography (CT scan) one month after treatment. CONCLUSION: LRFA of HCC proved to be a safe and effective technique. IOLUS is superior on spiral CT scan in detection a small HCC.

Open mesh-plug technique in inguinal hernia repair--short-term results.

OBJECTIVE: To evaluate the safety, technical problems, early complications and short-term results of the mesh-plug technique in primary and recurrent inguinal hernia repair. DESIGN: Prospective study. SETTING: Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia. SUBJECTS: Two hundred and forty-four patients with 256 hernias were admitted through a specialised hernia clinic between May 1997 and June 1998. There were 236 men and 8 women, with a mean age of 50 years (range 17-90 years). INTERVENTIONS: Repair of the inguinal hernia using the mesh-plug technique. RESULTS: Concomitant medical problems were present in 7.3% of patients. The size of the hernia was assessed preoperatively and recorded as either inguinal (73%) or inguino-scrotal (33%). The site of the hernia was right in 55.7% of patients, left in 48% and bilateral in 4.9%. Furthermore, types and Gilbert's classification were assessed intraoperatively. The mean operative time was 41.61 +/- 10.59 minutes and the mean hospital stay was 1.14 +/- 2.63 days. No perioperative mortality occurred in this series. General complications were vomiting in 4 cases and 6 cases of chest infection. Local complications included 2 would infections (0.8%), 26 skin bruises (10.7%), 6 scrotal swellings (2.5%), 2 cases of cord thickening (0.8%) and 16 cases of postoperative neuralgia (6.6%). There were only 2 cases of recurrence (0.8%). CONCLUSION: Simplicity, safety, short operating time, and low rates of complications and recurrence were noted. The technique is promising and could be used for all types of primary and recurrent inguinal hernia as day surgery cases under local anaesthesia.