Acquired Port-Wine Stain: Not a simple stain!

n/

Anatomical variations of hepatic artery using the multidetector computed tomography angiography

Background: The frequency of normal and aberrant hepatic arteries differs among ethnicities. The aim of our work was to study the frequency of normal and aberrant hepatic arteries among Egyptians using multidetector computed tomography (MDCT) and to compare our prevalence with the prevalence of other nationalities. In addition, the gender differences of such variations were clarified. Moreover, the arterial feeding of hepatic segment IV was determined. Materials and methods: The present study was carried out on 500 patients (409 males and 91 females). Abdominal CT was performed using two MDCT systems, a 64-row, and a 256-slice system. Results: According to Michel’s classification, the normal anatomy (type I) was observed in 369 (73.8%) cases, while anomalous hepatic arterial pattern was detected in 131 (26.2%) cases. These anomalies were distributed as follows: type II in 36 (7.2%) cases, type III in 60 (12%) cases, types IV and V in 5 cases for each (1% each), type VI in 14 (2.8%) and types VIII and IX in a single case for each (0.2% each). Neither type VII nor type X was detected. Nine (1.8%) unclassified cases were observed. According to Hiaat’s classification, the anomalies were distributed as follows: type II in 41 (8.2%) cases, type III in 74 (14.8%) cases, type IV in 6 (1.2%) cases, type V in a single case (0.2%) and type VI in 2 (0.4%) cases. Finally, 7 (1.4%) unclassified cases were observed. Common hepatic artery (CHA) originated from coeliac trunk in 98% (79.8% males and 18.2% females). It originated from the abdominal aorta in 0.4% and from the superior mesenteric artery (SMA) in 0.4%. It was absent in 1.2%. Right hepatic artery (RHA) originated from the CHA in 86.6% (69.8% males and 16.8% females) and from the SMA in 13.2% (11.8% males and 1.4% females) and from the abdominal aorta in 0.2% (a single male case). Left hepatic artery (LHA) originated from the CHA in 91.2% and from the left gastric artery (LGA) in 8.8%. The most common origin of the segment IV blood supply was the LHA in 60.8%, followed by the RHA in 35%. Less commonly, blood supply derived from the hepatic artery proper (HAP) in 1%. Combined supply derived from RHA and LHA in 0.8%, from the LHA and HAP in 2% and the least encountered was from the RHA and HAP in 0.4%. Conclusions: Hepatic artery variations among Egyptians have a different distribution when compared to such variations among other species. The normal hepatic arterial pattern was observed in 73.8%, while the anomalous was detected in 26.2%. The CHA originated from the coeliac trunk in 98%, the RHA originated from the CHA in 86.6% and the LHA originated from the CHA in 91.2%. The most common arterial supply of the hepatic segment IV is derived from the LHA (60.2%)

Evaluation of laparoscopic-assisted anorectoplasty for the management of intermediate and high anorectal malformations in boys: Mansoura experience

Introduction: Laparoscopic-assisted anorectoplasty (LAARP) has been gaining great popularity for management of imperforate anus. This study aims to evaluate the use of this technique for high and intermediate anorectal malformations in boys.Patients and methods: From December 2012 to December 2016, we performed LAARP on 20 boys, all of which were colostomized at birth. Findings regarding the patients’ age at operation, type of anomaly, associated morbidities, sacral ratios, operative time, intraoperative complications, hospital stay, immediate/long-term postoperative complications, and reoperations were noted. Postoperatively, we evaluated the patients using barium enema, an ascending and voiding cystourethrogram, pelvic MRI, and a functional continence evaluation questionnaire.Results: A total of 11 patients presented with rectourethral bulbar fistula (RBF), seven with rectourethral prostatic fistula (RPF), one with rectovesical fistula, and one with no fistula. Mean sacral ratio was 0.82 ± 0.19. Mean age at time of LAARP was 236 ± 77 days. Mean operative time was 152 ± 32 min. Our most common intraoperative complication was peritoneal contamination (20%). Incidence of rectal mucosal prolapse was 40%. Barium enema revealed a mean rectoanal angle of 107 ± 13°. Ascending and voiding cystourethrogram revealed a residual urethral diverticulum in seven cases, six of which had RBFs. Mean MRI placement score obtained was 0.76± 0.51 denoting excellent rectal position.Conclusion: Usage of LAARP to manage high and intermediate anorectal malformations in boys is feasible, allowing accurate rectal placement within the muscle complex and with good postoperative functional results. Residual urethral diverticulum occurred more frequently in patients with RBF. Incidence of mucosal prolapse is high after LAARP and should be avoided.Keywords: laparoscopic-assisted anorectoplasty, anorectal malformations, residual urethral diverticulum post LAAR

Variables and Strategies in Development of Therapeutic Post-Transcriptional Gene Silencing Agents

Post-transcriptional gene silencing (PTGS) agents such as ribozymes, RNAi and antisense have substantial potential for gene therapy of human retinal degenerations. These technologies are used to knockdown a specific target RNA and its cognate protein. The disease target mRNA may be a mutant mRNA causing an autosomal dominant retinal degeneration or a normal mRNA that is overexpressed in certain diseases. All PTGS technologies depend upon the initial critical annealing event of the PTGS ligand to the target RNA. This event requires that the PTGS agent is in a conformational state able to support hybridization and that the target have a large and accessible single-stranded platform to allow rapid annealing, although such platforms are rare. We address the biocomplexity that currently limits PTGS therapeutic development with particular emphasis on biophysical variables that influence cellular performance. We address the different strategies that can be used for development of PTGS agents intended for therapeutic translation. These issues apply generally to the development of PTGS agents for retinal, ocular, or systemic diseases. This review should assist the interested reader to rapidly appreciate critical variables in PTGS development and facilitate initial design and testing of such agents against new targets of clinical interest

A Predictive Model for Steady State Ozone Concentration at an Urban-Coastal Site

Ground level ozone (O3) plays an important role in controlling the oxidation budget in the boundary layer and thus affects the environment and causes severe health disorders. Ozone gas, being one of the well-known greenhouse gases, although present in small quantities, contributes to global warming. In this study, we present a predictive model for the steady-state ozone concentrations during daytime (13:00–17:00) and nighttime (01:00–05:00) at an urban coastal site. The model is based on a modified approach of the null cycle of O3 and NOx and was evaluated against a one-year data-base of O3 and nitrogen oxides (NO and NO2) measured at an urban coastal site in Jeddah, on the west coast of Saudi Arabia. The model for daytime concentrations was found to be linearly dependent on the concentration ratio of NO2 to NO whereas that for the nighttime period was suggested to be inversely proportional to NO2 concentrations. Knowing that reactions involved in tropospheric O3 formation are very complex, this proposed model provides reasonable predictions for the daytime and nighttime concentrations. Since the current description of the model is solely based on the null cycle of O3 and NOx, other precursors could be considered in future development of this model. This study will serve as basis for future studies that might introduce informing strategies to control ground level O3 concentrations, as well as its precursors’ emissions

A Predictive Model for Steady State Ozone Concentration at an Urban-Coastal Site

Ground level ozone (O-3) plays an important role in controlling the oxidation budget in the boundary layer and thus affects the environment and causes severe health disorders. Ozone gas, being one of the well-known greenhouse gases, although present in small quantities, contributes to global warming. In this study, we present a predictive model for the steady-state ozone concentrations during daytime (13:00-17:00) and nighttime (01:00-05:00) at an urban coastal site. The model is based on a modified approach of the null cycle of O-3 and NOx and was evaluated against a one-year data-base of O-3 and nitrogen oxides (NO and NO2) measured at an urban coastal site in Jeddah, on the west coast of Saudi Arabia. The model for daytime concentrations was found to be linearly dependent on the concentration ratio of NO2 to NO whereas that for the nighttime period was suggested to be inversely proportional to NO2 concentrations. Knowing that reactions involved in tropospheric O-3 formation are very complex, this proposed model provides reasonable predictions for the daytime and nighttime concentrations. Since the current description of the model is solely based on the null cycle of O-3 and NOx, other precursors could be considered in future development of this model. This study will serve as basis for future studies that might introduce informing strategies to control ground level O-3 concentrations, as well as its precursors' emissions.Peer reviewe

A Predictive Model for Steady State Ozone Concentration at an Urban-Coastal Site

Ground level ozone (O3) plays an important role in controlling the oxidation budget in the boundary layer and thus affects the environment and causes severe health disorders. Ozone gas, being one of the well-known greenhouse gases, although present in small quantities, contributes to global warming. In this study, we present a predictive model for the steady-state ozone concentrations during daytime (13:00–17:00) and nighttime (01:00–05:00) at an urban coastal site. The model is based on a modified approach of the null cycle of O3 and NOx and was evaluated against a one-year data-base of O3 and nitrogen oxides (NO and NO2) measured at an urban coastal site in Jeddah, on the west coast of Saudi Arabia. The model for daytime concentrations was found to be linearly dependent on the concentration ratio of NO2 to NO whereas that for the nighttime period was suggested to be inversely proportional to NO2 concentrations. Knowing that reactions involved in tropospheric O3 formation are very complex, this proposed model provides reasonable predictions for the daytime and nighttime concentrations. Since the current description of the model is solely based on the null cycle of O3 and NOx, other precursors could be considered in future development of this model. This study will serve as basis for future studies that might introduce informing strategies to control ground level O3 concentrations, as well as its precursors’ emissions

New particle formation, growth and apparent shrinkage at a rural background site in western Saudi Arabia

Atmospheric aerosols have significant effects on human health and the climate. A large fraction of these aerosols originates from secondary new particle formation (NPF), where atmospheric vapors form small particles that subsequently grow into larger sizes. In this study, we characterize NPF events observed at a rural background site of Hada Al Sham (21.802 degrees N, 39.729 degrees E), located in western Saudi Arabia, during the years 2013-2015. Our analysis shows that NPF events occur very frequently at the site, as 73 % of all the 454 classified days were NPF days. The high NPF frequency is likely explained by the typically prevailing conditions of clear skies and high solar radiation, in combination with sufficient amounts of precursor vapors for particle formation and growth. Several factors suggest that in Hada Al Sham these precursor vapors are related to the transport of anthropogenic emissions from the coastal urban and industrial areas. The median particle formation and growth rates for the NPF days were 8.7 cm(-3) s(-1) (J(7)(nm)) and 7.4 nm h(-1) (GR(7-12nm)), respectively, both showing highest values during late summer. Interestingly, the formation and growth rates increase as a function of the condensation sink, likely reflecting the common anthropogenic sources of NPF precursor vapors and primary particles affecting the condensation sink. A total of 76 % of the NPF days showed an unusual progression, where the observed diameter of the newly formed particle mode started to decrease after the growth phase. In comparison to most long-term measurements, the NPF events in Hada Al Sham are exceptionally frequent and strong both in terms of formation and growth rates. In addition, the frequency of the decreasing mode diameter events is higher than anywhere else in the world.Peer reviewe

Prognostic DNA methylation markers for sporadic colorectal cancer: a systematic review

Background Biomarkers that can predict the prognosis of colorectal cancer (CRC) patients and that can stratify high-risk early stage patients from low-risk early stage patients are urgently needed for better management of CRC. During the last decades, a large variety of prognostic DNA methylation markers has been published in the literature. However, to date, none of these markers are used in clinical practice. Methods To obtain an overview of the number of published prognostic methylation markers for CRC, the number of markers that was validated independently, and the current level of evidence (LoE), we conducted a systematic review of PubMed, EMBASE, and MEDLINE. In addition, we scored studies based on the REMARK guidelines that were established in order to attain more transparency and complete reporting of prognostic biomarker studies. Eighty-three studies reporting on 123 methylation markers fulfilled the study entry criteria and were scored according to REMARK. Results Sixty-three studies investigated single methylation markers, whereas 20 studies reported combinations of methylation markers. We observed substantial variation regarding the reporting of sample sizes and patient characteristics, statistical analyses, and methodology. The median (range) REMARK score for the studies was 10.7 points (4.5 to 17.5) out of a maximum of 20 possible points. The median REMARK score was lower in studies, which reported a p value below 0.05 versus those, which did not (p = 0.005). A borderline statistically significant association was observed between the reported p value of the survival analysis and the size of the study population (p = 0.051). Only 23 out of 123 markers (17%) were investigated in two or more study series. For 12 markers, and two multimarker panels, consistent results were reported in two or more study series. For four markers, the current LoE is level II, for all other markers, the LoE is lower. Conclusion This systematic review reflects that adequate reporting according to REMARK and validation of prognostic methylation markers is absent in the majority of CRC methylation marker studies. However, this systematic review provides a comprehensive overview of published prognostic methylation markers for CRC and highlights the most promising markers that have been published in the last two decades