Two-stage repair of low anorectal malformations in girls: is it truly a setback?

Background/purpose Anorectal malformations (ARMs) affect 1 in 4000–5000 births. Low ARMs are nowadays treated in the first stage rather than at second or third stages. However, reports suggest problems with continence in these children because of wound dehiscence and infection; thus, protective colostomy may still be recommended. Colostomies do have complications, but the question is whether these disadvantages outweigh the protective effect on wound healing after anal reconstruction. The aim of this study was to define whether two-stage repair of low ARMs in girls is truly a setback or whether it is beneficial.Patients and methods During the period of June 2008–June 2012, 30 female patients suffering from low ARMs were admitted to Mansoura University Children Hospital. Their ages at the time of surgery ranged from 3 to 11 months (mean age 6.2) and they were divided into two equal groups. The fistula location was defined either anocutaneous or anovestibular according to the Pena classification. The choice of management was totally randomized; thus, patients of group A underwent a two-stage posterior sagittal anorectoplasty and group B patients underwent a one-stage posterior sagittal anorectoplasty operation. Data recorded included age, fistula location, associated anomalies, operation performed, operative time, length of hospital stay, approximate cost, and postoperative complications.Results A comparison of data showed that treatment of patients of group A involved more time and money and they had a longer duration of hospital stay than did patients of group B. Seven patients (47%) in group A and nine patients (60%) in group B showed postoperative complications. Wound infection occurred in three patients (20%) of group A and in eight patients (53%) of group B. More importantly, two (13%) wound disruptions occurred among the three cases with wound infection in group A, whereas six (40%) disruptions occurred among the eight patients (53%) with wound infections in group B. The incidence of redo operation in group B was found to be significantly higher than in group A. Mucosal prolapse occurred in only one patient (7%) of group B. Complications related to colostomy occurred in group A only; five patients (33%) suffered skin excoriation around the stoma and one patient (7%) showed a prolapsed distal stoma loop. Constipation was noted during follow-up in five patients (33%) of group A and in six patients (40%) of group B.Conclusion Two-stage repair of low ARM in girls is truly beneficial, as we could perform a successful operation and achieve continence in the child regardless of the complications of colostomy, which are temporary and tolerable.Keywords: anorectal malformations, colostomy, posterior sagittal anorectoplasty, two-stage repair of low anorectal malformatio

Exercise Mimetics: An Emerging and Controversial Topic in Sport and Exercise Physiology

Over the previous decade, there has been growing and fervent interest in scientific and commercial circles regarding the potential of bioactive compounds that mimic, or augment, the effects of exercise. These developments have given rise to the moniker ‘exercise pills’ or ‘exercise mimetics’. The emergence of such orally-delivered bioactive compounds could hold substantial therapeutic value for combating metabolic disease. Such treatments might also present therapeutic value for morbidly obese individuals or those recovering from severe injury. This topic is not without controversy, however, as the search for a ‘one size fits all’ solution is not likely to bear fruit, given the complexity of the molecular and physiological mechanisms involved. The primary goal of this chapter is to explore the challenges of designing a pill that might reliably deliver the myriad and complex adaptations afforded by exercise training, with a focus on skeletal muscle. Furthermore, it will consider the issues, rationale, and practicality of implementing such therapeutics as a credible substitute to engaging in regular exercise training

Detection of HER-2/neu, c-myc amplification and p53 inactivation by FISH in Egyptian patients with breast cancer

Breast cancer is a leading cause of cancer-related deaths in women worldwide. The clinical course of this disease is highly variable and clinicians continuously search for prognostic parameters that can accurately predict prognosis, and indicate a suitable adjuvant therapy for each patient. Amplification of the two oncogenes HER-2/neu and c-myc and inactivation of the tumor suppressor gene p53 are frequently encountered in breast carcinomas. The purpose of this study was to use the fluorescence in situ hybridization (FISH) for the assessment of HER-2/neu and c-myc amplification and p53 inactivation and to relate these molecular markers with the commonly used clinical and pathological factors. The study was conducted on 34 tissue samples obtained from 33 females and 1 male with breast carcinomas and 17 samples obtained from 16 females and 1 male with benign breast lesions. Results revealed that the level of HER-2/neu, c-myc and p53 in the malignant group was significantly increased as compared to the benign group. On relating the level of the molecular markers to clinicopathological factors, p53 was significantly associated with increased patient’s age. The sensitivity of the investigated markers significantly increased with larger tumor size. Concerning tumor grade, HER-2/neu and p53 showed a significant increase in low-grade tumors whereas c-myc showed a highly significant increase in high-grade tumors. With regard to disease staging, HER-2/neu and c-myc were the only markers that showed significant increase at late stages of disease. p53 and HER-2/neu were significantly associated with positive lymph nodal status. A significant correlation was obtained between the levels of the three biomarkers to each other. Conclusively, the combination of HER-2/neu, c-myc and p53 can stratify patients into different risk groups

Expression and purification of recombinant Shiga toxin 2B from Escherichia coli O157:H7

Enterohemorrhagic Escherichia coli are important human food-borne pathogens. Recently, Shiga toxinproducing E. coli (STEC) causes life-threatening hemolytic-uremic syndrome (HUS). In this study, Stx2B gene, a subunit of Shiga toxin, was amplified via polymerase chain reaction (PCR) from the chromosomal DNA of clinical fecal sample using appropriate primers. The PCR product was cloned to commercially available plasmid pH6HTN His6HaloTag® T7 containing two purification tags, namely, six histadine tag and Halo tag. The integrity of the constructed plasmid was confirmed using restriction enzyme mapping and sequencing. Then, Stx2B protein expressed after induction with isopropyl β-D-1-thiogalactopyranoside (IPTG) in E. coli JM109 (DE3) under the control of the T7 promotor. The two step purification trains were used to purify native Stx2B. First step purification was Ni-immobilized metal ion affinity chromatography (IMAC) column, followed by second step using HaloLink resin. The native Stx2B was obtained after column cleavage of halo-tag using HaloTEV protease. Maximum protein expression of Stx2B economically was obtained using 1 mM IPTG for 4 h at 37°C. Protein identity was confirmed by a band at ~11.4 kDa using 15% sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and StxB2 yield was 450 μg ml-1 confirmed by Bradford assay. Recombinant Stx2B protein was produced in highly pure yield using HaloTag technology.Key words: Escherichia coli O157:H7, StxB gene, expression, HaloTag technology, purification

Reconstruction of Femur Length Using the Epiphysial and Diaphysial Diameters in Contemporary Egyptian Sample, with Application to Ancient Egyptians

Inferences in bioarchaeology and forensic contexts require mathematical stature estimation using long bone lengths. This study is in hand to identify predictors of femur length (FL) from epiphyseal and diaphysial width measurements that are not bound to assumptions of sex or laterality. Both standard and new measurements around dominant foramen nutricium (NF) were collected on modern femora (n=64) from Alexandria university unidentified skeletal Collection to compute linear regression models. Four equations were then validated on Ancient Egyptian sample (n=73) from Goldman’s Osteometric dataset to evaluate effect of sex subdivision on the prediction accuracy of FL and indirect stature estimation using Raxter’s formulae. Most of models reflected significant positive association r\u3e0.60) between width variables and FL. Oddly, the distance from proximal end to NF correlated weakly with FL (r=0.34). The stepwise selected equations preferred measurements around NF to midshaft where the anteroposterior diameter was included in proximal fragment model (r=0.77) and circumference in diaphyseal fragment model (r=0.62). Tested equations performed consistently on the ancient Egyptian sample. Measurements from femoral proximal fragment are more reliable predictors than distal fragment with the exception of femur neck diameter. However, distal epicondylar breadth is a better predictor of FL in females than in males. Indirect stature estimation showed a reasonable degree of accuracy in both sexes. These models can be applied successfully in Contemporary and Ancient Egyptians fragmentary remains however, due to larger size of femora from Old Kingdom sample, they would be most applicable to individuals from the following dynasties

Hemodialysis associated dysautonomia; Effect of optimization of dialysis and nutrition: A prospective study

Background: Autonomic neuropathy is common among hemodialysis patients, even if they are asymptomatic. The aim of this study is to assess the effect of optimization of patients' dialysis and nutrition on the presence of autonomic dysfunction in these patients guided by sympathetic skin response (SSR) test. Methods: Fifteen patients on maintenance hemodialysis (12 males and 3 females) their age ranged from 24 to 67 years, most of them were on bicarbonate dialysis were included in our study. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling. Their nutrition was assessed by laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Their autonomic functions were assessed by clinical examination, hand grip and SSR test. Dialysis dose was readjusted to achieve a target kt/v value of 1.3/session thrice weekly. Also, their nutrition was reviewed to achieve nPCR of 1.2 gm/kg/day and caloric intake of 30-40 KCal/kg/day through diet manipulation and support. They were reassessed after 3 months. Results: Analysis of the data showed a statistically significant improvement of the observed subclinical autonomic neuropathy evidenced by a significant change in the hand grip (p = 0.044), and a high statistically significant improvement in the sympathetic skin response test parameters (both amplitude and latency) (p=0.001) after optimization of both hemodialysis and nutrition status. Conclusion: Improving dialysis and patients nutrition by using urea kinetic modeling is valuable in improving their autonomic functions as assessed by SSR test

A new least squares method for estimation and prediction based on the cumulative Hazard function

In this paper, the cumulative hazard function is used to solve estimation and prediction problems for generalized ordered statistics (defined in a general setup) based on any continuous distribution. The suggested method makes use of Rényi representation. The method can be used with type Ⅱ right-censored data as well as complete data. Extensive simulation experiments are implemented to assess the efficiency of the proposed procedures. Some comparisons with the maximum likelihood (ML) and ordinary weighted least squares (WLS) methods are performed. The comparisons are based on both the root mean squared error (RMSE) and Pitman's measure of closeness (PMC). Finally, two real data sets are considered to investigate the applicability of the presented methods