Nucleotide Oligomerization Domain-like receptor 4 (NLR4) Gene Expression and Interleukin 1-β (IL 1-β) Level in Urine Samples Before and After Intravesical BCG Therapy For Treatment of Bladder Cancer

Bladder cancer is the 7th most commonly diagnosed cancer in males worldwide and the 11th when both genders are considered. Seventy five per cent of bladder cancer cases are non-muscle invasive bladder cancer (NMIBC). Bacillus Calmette–Gu rin (BCG) immunotherapy remains the standard intravesical agent for NMIBC. The exact mechanism by which BCG prevents recurrence is unknown. The aim of this study was to evaluate NLR4 gene expression and IL-1β as possible prognostic indicators for NMIBC recurrence and BCG treatment failure, and to detect the difference in their levels among muscle invasive bladder cancer (MIBC) and NMIBC that may aid in primary differentiation between cases. This study was conducted in 30 patients who had NMIBC and 17 patients who had MIBC. Urine samples were obtained in sterile cups before operation. From NMIBC cases, four more samples were obtained as mentioned below. Evaluation of NLR4 gene expression was performed in pre-surgical sample for MIBC and in 4 samples for NMIBC: pre-surgical sample, sample collected 4 hours after the 3rd dose of BCG instillation, and samples collected during follow up (3 and 6 months post-surgically). There was statistical significant increase in NLRP4 expression levels in NMIBC (CT=0.87±1.48) compared to MIBC (CT=2.82±2.07). As far as we searched, no published results were found regarding comparative gene expression levels between NMIBC and MIBC cases. Gene expression in recurrent cases was higher in pre-surgical urine samples than in non-recurrent cases. The expression level further increased up to 21 fold than the pre-surgical level in the sample taken after injection of the 3rd dose of BCG. This level decreased distinctly to become 1-fold increase over pre-surgical level at the 3rd month follow up then to only 0.9-fold at the 6th month. In non- recurrent cases, gene expression level started pre-surgically in much lower levels than those encountered in recurrent cases. There were 11-fold increase in expression level after 3rd dose of BCG instillation and then decreased to be 5.6 folds higher in the sample taken at 3rd month follow up than in presurgical samples. Gene expression further decreased to become 4.1 fold higher in samples taken at 6 month follow up than the pre-surgical levels. IL-1β levels were estimated for NMIBC and MIBC cases in urine samples pre-surgically and during BCG therapy in case of NMIBC before and 4 hours after the 3rd dose and during 3rd month follow-up of those cases for searching its possible use of for primary differentiation between NMIBC and MIBC, and also as a prognostic factor for possible recurrence in case of NMIBC cases. The level of IL-1β was generally higher in pre-surgical samples (0.62±0.12 pg/ml) when compared to its level before the 3rd dose of BCG induction therapy (0.53±0.13 pg/ml). Its level was distinctly higher four hours after administration of the 3rd dose BCG (1.96±0.62 pg/ml) than both previous levels. Levels decreased bellow pre-surgical level at 3rd month follow up (0.57±0.099 pg/ml). The levels of IL-1β estimated in samples collected four hours after the 3rd dose BCG was higher in cases that showed recurrence later on than non-recurrent cases. The levels decreased in both cases and became higher in non-recurrent cases (0.64±0.05 pg/ml) than in cases already developed recurrence at the 3rd month diagnosed during follow-up (0.45±0.05 pg/ml). To conclude, on following NLRP4 gene expression and IL-1β levels during BCG administration among recurrent and non-recurrent cases of thirty NMIBC cases, there was a significant statistical difference in both levels for the samples collected after the third dose BCG, being higher in patients who showed subsequent recurrence at the 3rd and 6th month of follow-up. If these preliminary reported findings will be confirmed in upcoming larger cohort’s studies, it could be promising in prognosis of such cases, with the possibility of early manipulation of individualized treatment schedule, keeping patients most probably prone to encounter recurrence safe from possible side effects of BCG therapy. The assessment of NLRP4 expression and IL-1β levels could help predict failure of BCG therapy, playing an appreciable role in early deciding radical surgery. When comparing NLRP4 expression and IL-1β levels between MIBC and NMIBC cases, increased values were noted among non-invasive ones. This finding may serve as a possible diagnostic tool, which represents a challenging issue. Hence, cut-off values for gene expression and cytokine level are to be specified

Sustainable healthcare futures: how digital leadership stimulates nurses’ green creativity: a quasi-experimental study

Background: In the context of increasing environmental consciousness, integrating sustainable practices in healthcare is essential. Nurses’ green creativity, defined as their ability to generate innovative, eco-friendly solutions, is pivotal in this transformation. Digital leadership, which leverages technology to guide sustainable practices, plays a critical role in fostering this creativity among nurses. Aim: This study aimed to investigate the impact of digital leadership on enhancing nurses’ green creativity and to evaluate the effectiveness of digital leadership strategies in promoting sustainability within healthcare settings. Research hypothesis: H1: Participation in a digital leadership program will lead to a significant enhancement in nurses’ knowledge about digital leadership.H2: A digital leadership program will have a significantly positive impact on fostering nurses’ green creativity. Methods: A quasi-experimental design was employed, involving 128 nurses randomly assigned to intervention and control groups. The intervention group participated in a digital leadership training program. Data were collected using a self-administered questionnaire, the Digital Leadership Competency Scale, and the Green Creativity Scale, before and after the intervention. Results: The mean knowledge score in the intervention group increased from 15.21 ± 4.22 pre-intervention to 44.29 ± 2.61 post-intervention (p < 0.001). For digital leadership competency, the mean score in the intervention group rose from 191.67 ± 20.43 to 552.14 ± 16.72 (p < 0.001). The mean score for green creativity in the intervention group significantly improved from 15.58 ± 1.68 to 42.31 ± 2.54 (p < 0.001). Conclusion: The study concluded that digital leadership programs significantly enhance nurses’ green creativity. Integrating digital leadership into nursing practice can promote sustainability and innovation in healthcare settings.Princess Nourah Bint Abdulrahman University, PNU; Abdulrahman University, (PNURSP2025R844)Princess Nourah bint Abdulrahman University, Project number (PNURSP2025R844), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Reliability of using nondestructive tests to estimate compressive strength of building stones and bricks

AbstractThis study aims to investigate the relationships between Schmidt hardness rebound number (RN) and ultrasonic pulse velocity (UPV) versus compressive strength (fc) of stones and bricks. Four types of rocks (marble, pink lime stone, white lime stone and basalt) and two types of burned bricks and lime-sand bricks were studied. Linear and non-linear models were proposed. High correlations were found between RN and UPV versus compressive strength. Validation of proposed models was assessed using other specimens for each material. Linear models for each material showed good correlations than non-linear models. General model between RN and compressive strength of tested stones and bricks showed a high correlation with regression coefficient R2 value of 0.94. Estimation of compressive strength for the studied stones and bricks using their rebound number and ultrasonic pulse velocity in a combined method was generally more reliable than using rebound number or ultrasonic pulse velocity only

Effect of filler types on physical, mechanical and microstructure of self compacting concrete and Flow-able concrete

AbstractThe objective of this study is to evaluate the effect of various filler types on the fresh and hardened properties of self-compacting concrete (SCC) and Flow-able concrete. For this purpose, two groups of fillers were selected. The first group was pozzolanic fillers (silica fume and metakaolin) while the second group was non-pozzolanic fillers (limestone powder, granite dust and marble dust). Cement contents of 400kg/m3 and 500kg/m3 were considered while the used filler material was 7.5%, 10% and 15%. Slump and slump flow, T50, sieve stability and bleeding tests were performed on fresh concrete. The studied hardened properties included unit weight, voids ratio, porosity, and water absorption and cube compressive strength. In addition, thermo-gravimetric analysis, X-ray diffraction analysis and scanning electronic microscope were performed. The test results showed that filler type and content have significant effect on fresh concrete properties where non-pozzolanic fillers improve segregation and bleeding resistance. Generally, filler type and content have significant effect on unit weight, water absorption and voids ratio. In addition, non-pozzolanic fillers have insignificant negative effect on concrete compressive strength. Finally, there was a good correlation between fresh concrete properties and hardened concrete properties for SCC and Flow-able concrete

Long term study of mechanical properties, durability and environmental impact of limestone cement concrete

AbstractIn this study, properties of limestone cement concrete containing different replacement levels of limestone powder were examined. It includes 0%, 5%, 10%, 15%, 20% and 25% of limestone powder as a partial replacement of cement. Silica fume was added incorporated with limestone powder in some mixes to enhance the concrete properties. Compressive strength, splitting tensile strength and modulus of elasticity were determined. Also, durability of limestone cement concrete with different C3A contents was examined. The weight loss, length change and cube compressive strength loss were measured for concrete attacked by 5% sodium sulfate using an accelerated test up to 525days age. The corrosion resistance was measured through accelerated corrosion test using first crack time, cracking width and steel reinforcement weight loss. Consequently, for short and long term, the use of limestone up to 10% had not a significant reduction in concrete properties. It is not recommended to use blended limestone cement in case of sulfate attack. The use of limestone cement containing up to 25% limestone has insignificant effect on corrosion resistance before cracking