Does Surgical Resection of the Primary Tumor in Patients with Stage IV Breast Cancer Improve Survival?

Several lines of evidence suggest that it is time to re-examine the approach to the patient diagnosed with distant metastases at the initial breast cancer presentation.The aim of this study was to evaluate the impact of surgical therapy of the primary tumor and other clinical and staging factors on overall survival of patients with stage IV breast cancer. Patients and methods: This retrospective study included patients with stage IV breast cancer from 2000 to 2008. Patient's characteristics and survival distilled from medical files were evaluated using multivariate analysis.Results: Of 330 patients included in this study, 132 underwent surgery in the form of mastectomy. Local surgery of the primary tumor, lower TN staging, younger age, positive receptor status, lack of Her-2 amplification, bone –only metastasis and one site metastasis were associated with significantly higher survival while grade and pathological type were not. Median overall survival time for no surgery group was 15 months and 27 months for mastectomy group (P = 0.003).Three-year survival rate was higher for patients who did have surgery (34% vs 16%). Conclusion: Removal of the primary tumor in patients with primary distant metastatic breast cancer was associated with significantly higher survival. However, carefully designed prospective randomized trials are needed to confirm these results

Egypt's livestock owners' struggles with technology

Technology plays a crucial role in modernizing and improving various industries, including agriculture. However, in the context of livestock farming in Egypt, many livestock owners face significant challenges in adopting and utilizing technology effectively. This article explores the struggles faced by Egypt's livestock owners in integrating technology into their operations. It discusses the barriers hindering technology adoption, the potential benefits of technology in livestock farming, and suggests strategies to overcome these challenges. The information presented in this study is based on existing literature and studies conducted in Egypt, highlighting the need for targeted interventions to support technology integration in the livestock sector

The Effect of Contrast Agents on Dose Calculations of Volumetric Modulated Arc Radiotherapy Plans for Critical Structures

Radiotherapy dose calculation requires accurate Computed Tomography (CT) imaging while tissue delineation may necessitate the use of contrast agents (CA). Acquiring these two sets is a common practice in radiotherapy. This study aims to evaluate the effect of CA on the dose calculations. Two hundred and twenty-six volumetric modulated arc therapy (VMAT) patients that had planning CT with contrast (CCT) and non-contrast CT (NCCT) of different cancer sites (e.g., brain, head, and neck (H&N), chest, abdomen, and pelvis) were evaluated. Treatment plans were recalculated using CCT, then compared to NCCT. The variation in Hounsfield units (HU) and dose distributions for critical structures and target volumes were analyzed using mean HU, mean and maximum relative dose values, D2%, D98%, and 3D gamma analysis. HU variations were statistically significant for most structures. However, this was not clinically significant as the difference in mean HU values was within 30 HU for soft tissue and 50 HU for lungs. Variation in target volumes’ D2% and D98% were insignificant for all sites except brain and nasopharynx. Dose maximum differences were within 2% for the majority of critical structures and target volumes. 3D gamma analysis results revealed that majority of plans satisfied the 2% and 2 mm criteria. CCT may be acquired for VMAT radiotherapy planning purposes instead of NCCT, since there is no clinically significant difference in dose calculations based on either image set

Fortified foods to improve the general immunity of animals in Egypt (mini review)

The present study investigates the efficacy of fortified animal feeds in enhancing the general immunity of livestock, poultry, and aquatic species in Egypt. Given the significant role of nutrition in supporting the immune system and combating infectious diseases, this research aims to provide evidence-based recommendations for the use of vitamin, mineral, and phytonutrient-enriched feeds to bolster the health and productivity of Egypt's animal husbandry sector

Mixed Climatology, Non-synoptic Phenomena and Downburst Wind Loading of Structures

Modern wind engineering was born in 1961, when Davenport published a paper in which meteorology, micrometeorology, climatology, bluff-body aerodynamics and structural dynamics were embedded within a homogeneous framework of the wind loading of structures called today \u201cDavenport chain\u201d. Idealizing the wind with a synoptic extra-tropical cyclone, this model was so simple and elegant as to become a sort of axiom. Between 1976 and 1977 Gomes and Vickery separated thunderstorm from non-thunderstorm winds, determined their disjoint extreme distributions and derived a mixed model later extended to other Aeolian phenomena; this study, which represents a milestone in mixed climatology, proved the impossibility of labelling a heterogeneous range of events by the generic term \u201cwind\u201d. This paper provides an overview of this matter, with particular regard to the studies conducted at the University of Genova on thunderstorm downbursts

Non-linear bending vibrations of beams

M.S.Francis M. Hil

Time-dependent response of flat plate structures under high sustained load

[EMBARGOED UNTIL 8/1/2023] Reinforced concrete (RC) structures may be exposed to high levels of sustained stresses resulting from errors in construction or design, abnormal loading, and material degradation. Although most RC structures are designed to withstand service level load with a large safety factor, errors may cause failure or overloading in a RC member. This in turn may lead to a high sustained load in RC members and nonlinear concrete creep that may eventually lead to partial or complete collapse. In the past decade, previous research has considered disproportionate collapse by looking at the instantaneous removal of one member. However, the overall time-dependent response of the member and how that response can lead to structural collapse is unknown. This research aims to understand the impact of high sustained loads on the evolution of structural collapse in reinforced concrete flat-plate buildings and develop modeling methods capable of analyzing RC structures under high sustained load. In order to isolate and study aged concrete behavior under high sustained load, ASTM C512 (2010) compressive tests on plain concrete cylinders were conducted under sustained load levels ranging from 68 percent to 76 percent of the compressive strength of concrete. Concrete subjected to a sustained load level [greater than or equal to] 71 percent failed when reaching the inelastic strain capacity. The average times to failure for specimens were inversely proportional to the load levels that they were 105 and 35 hours for concrete subjected to sustained load levels of 71 percent le and 76 percent le (Group E), respectively. A model was presented to predict concrete creep's linear and nonlinear behavior under high sustained stresses. A comparison of the model with test results showed good agreement. In order to isolate and study bond behavior under high sustained load, ASTM A944 (2004) beam-end tests were subjected to sustained load levels ranging from 71 percent and 100 percent of their ultimate capacity and observed until failure or at least 20 days. Four-specimen groups consisting of 21 specimens constructed with scaled properties and average concrete age of 407 days were experimentally tested. Three of the specimens failed under sustained load at load levels as low as 80 percent of the control specimens. Subsequent loading of the remaining specimens showed that the application of sustained load did not reduce the ultimate residual capacity. The results also show that all specimens experienced timedependent bond-slip, which increased as the sustained load level increased. The study experimentally investigated the effect of concrete cover and bonded length on the bondslip. The results show that failure under sustained load may occur if sustained bond stress to concrete tensile strength exceeds 2.29. A simple time-dependent model for determining the bond-slip under high sustained loading was developed and validated with the available data. A finite element modeling method for the time-dependent response of RC members under high sustained load was developed and verified with experimental data. The models were built using a specially written user concrete material subroutine to simulate the concrete behavior under short-term and high sustained loading. The increase in concrete tension strain caused by time-dependent bond-slip between reinforcement steel and concrete was taken into account and incorporated into the concrete subroutine. A comparison of the model with experimental results of RC beam and slab-column tests (tested previously by the research team) as well as a RC substructure test (tested by the Defense Threat Reductions Agency (DTRA)) showed good agreement. The comparison of the FE model, with and without the time-dependent bond-slip effect, with experimental results, demonstrated the significance of taking time-dependent bond-slip into account. For example, The FE model's 25-day creep deflection in beam B7-SL was about 2 percent lower (when including time-dependent bond behavior) and 15 percent lower (when excluding timedependent bond behavior) than the experimental results. A parametric analysis was conducted considering the effect of concrete compressive strength, steel reinforcement ratio, concrete cover, and sustained load level on the behavior of RC beams and slab column connections. The FE failure of RC beams was observed at a sustained load level [greater than or equal to] 94 percent of the ultimate load. The FE failure of RC slab-column connections was observed at a sustained load level [greater than or equal to] 94 percent of the ultimate load. Overall, this research resulted in a more thorough understanding of the behavior of RC members under high sustained load and a FE modeling method capable of analyzing RC structures.Includes bibliographical references

67. Clinical and echocardiographic predicators of postoperative atrial fibrillation

Postoperative atrial fibrillation is the most common arrhythmia after coronary artery bypass grafting, with a reported incidence of 10–60%. Preoperative clinical and echocardiographic data, especially the atrial electromechanical interval, predict postoperative atrial fibrillation in elective coronary artery bypass patients. Methods: A prospective study evaluated preoperative clinical and echocardiographic data in 192 patients who underwent elective coronary artery bypass from 2010 to 2012. Results: 18 (9.37%) patients developed postoperative atrial fibrillation. Compared to patients without postoperative atrial fibrillation, these 18 had significantly longer intensive care unit and hospital stays, they were significantly older (58.62 ± 10.02 vs. 53.22 ± 8.23 years; p < 0.02), with a larger left atrial volume (83.39 ± 8.31 vs. 55.47 ± 8.37 cm3, p < 0.001), longer atrial electromechanical interval (133.67 ± 8.15 vs. 98.05 ± 6.71 ms p < 0.0001), and lower tissue Doppler imaging systolic velocity wave amplitude (6.6 ± 1 vs. 9.4 ± 2.2 cm s−1; p < 0.001); they also had a higher prevalence of hypertension (61.11% vs. 38.5%; p < 0.04). Using 115 ms as the cutoff value of atrial electromechanical interval enabled us to detect patients who developed postoperative atrial fibrillation with 100% sensitivity, 77% specificity, 78% positive predictive value, and 100% negative predictive value. Conclusion: Older hypertensive patients are at higher risk of developing postoperative atrial fibrillation. Preoperative measurement of atrial electromechanical interval by tissue Doppler echocardiography is a useful predictor of postoperative atrial fibrillation in coronary artery bypass patients

Molecular-size exclusion chromatography of gamma-glutamyltransferase fractions: a tool for investigating pathophysiology of liver disease and liver transplant

The aim of this study is test the diagnostic power of GGT fraction for hepatic diseases in comparison with that of total GGT and its usefulness in the setting of liver transplantation. Cirrhosis and chronic liver failure, and HCC are leading causes of morbidity and mortality worldwide. The diagnosis of cirrhosis and the determination of the etiology remain complex, in fact, no serologic test or radiological study can accurately diagnose cirrhosis. Besides, assays in most standard liver panels do not reflect the function of the liver correctly. With appropriately selected patients, liver transplantation is a definitive curative therapy for long-term survival and good quality of life for patients with end stage liver disease facing death. Accurate diagnosis and prognosis are essential for patients management pre and post-transplant, and for patients prioritization for organ allocation for liver transplantation. This requires the choice of biomarkers that provide adequate diagnostic information, at the minimum cost to more accurately select candidates for liver transplantation, to monitor post-transplant outcome and provide an optimal treatment regimen. Serum gamma-glutamyltransferase (GGT) activity is a sensitive marker of liver dysfunction, but its specificity is modest, in fact, its value increases in all liver dysfunctions. GGT has been already included in diagnostic algorithm (i.e.: the Fatty Liver Index, FLI), its specificity was high if considered with other markers, but low if considered alone. The currently used laboratory GGT assays do not allow discriminating among the different causes of GGT increase, thus reducing the clinical value and specificity of this otherwise sensitive disease biomarker. A new method based on molecular-size exclusion chromatography, followed by a GGT-specific post-column reaction, allowed to identify and quantify, in healthy subjects, 4 plasma GGT fractions with high sensitivity, specificity and reproducibility. These fractions, named big-GGT (b-GGT), medium-GGT (m-GGT), small-GGT (s-GGT), and free-GGT (f-GGT) showed different molecular weight (MW), i.e. 2000, 1000, 250 and 70 kDa, respectively. It has been previously shown that in healthy subjects f-GGT is the most abundant fraction, while b-GGT showed the highest degree of correlation with established cardiovascular risk factors. Interestingly b-GGT has been found in atherosclerotic plaques together with products deriving from the pro-oxidant reactions catalysed by the enzyme, The liver is one of the main organs that generates free radicals, one of the mechanisms of hepatocyte injury in response to diverse insults occurring in different pathological conditions. For example, oxidative stress has been demonstrated to be implicated as a cause of hepatic fibrosis. Besides, liver damage is characterized by increased iron storage which elicits a free-radical mediated peroxidation. In the period between February 2008 and April 2011, 264 patients during evaluation for liver transplant [215 men; median (25th – 75th percentile); age 54.5 (50-60 years)] were enrolled at the Department of Surgery, Liver Transplantation Unit of the University Hospital of Pisa. At the visit, attendees underwent anamnestic-physical examination and blood sampling for the laboratory assessment of liver function. In this cohort: 39 patients were diagnosed with metabolic cirrhosis (MC), 96 with viral cirrhosis (VC) 129 with viral cirrhosis and hepatocellular carcinoma (HCC). As control 200 blood donors were selected and studied for the determination of fractional GGT reference values. Blood samples were also collected from 14 LT recipients preoperatively before native liver hepatectomy (T0), and for 10 consecutive days post-transplant. Bile samples were collected intra-operatively during duct anastomosis (T0) and 10 days following the surgical procedure of transplantation through Kehr-tube. Standard assay of all blood tests were simultaneously performed according to the standard clinical laboratory procedures by automated analysers at the Clinical Laboratories of the University Hospital of Pisa. Analysis of total and fractional GGT was performed using an FPLC (fast protein liquid chromatography) system. Separation of fractional GGT was obtained by gel filtration chromatography and the enzymatic activity was quantified by post-column injection of the fluorescent substrate for GGT. The area under chromatogram peak is proportional to fractional GGT activity. Total area and fractional GGT area was calculated by a MatLab program. Localization of GGT protein in liver biopsies was performed by automated indirect immunohistochemical analysis, using a polyclonal antibody directed against the C-terminal 20 amino acids of GGT heavy chain. Histological sections were analysed using the image software MetaAnalisys. Different GGT fraction patterns were observed in cirrhotic patients and within the three sub cohorts (VC, MC, HC). s-GGT showed a broader and double profile not seen in controls, defined as s1-GGT and s2-GGT. The b/s ratio was lower in patients than controls. The diagnostic value of the b/s ratio was independent of the absolute values of total GGT and from the aetiology of the cirrhosis and the presence of liver cancer. Variations of the GGT fractions reflect different aspects of the liver cirrhosis: b-GGT behaves as a positive index of liver function, and reflects the progression of portal hypertension and splenomegaly; s2-GGT fraction reflects hepatocellular damage. GGT activity in human bile is higher than that found in plasma, showing only two peaks corresponding to plasma b-GGT and f-GGT fractions, while m- and s-GGT fractions were not detectable. Regarding the nature and characteristics of biliary complex corresponding to the plasma b-GGT, the part of b-GGT fraction insensitive to the direct action of papain can be released into the bile associated with membrane vesicles such as exosomes. Immunolocalization of GGT in patients and control biopsy demonstrated different abundance and tissue distribution all over the section and quantification of GGT in liver tissue suggest that there is not a direct relationship between tissue and circulating GGT enzyme levels. The post-operative course of the selected 14 patients was uneventful and there were no events of acute rejection. Soon after transplantation (24h), a sharp decline in total plasma GGT is observed and reflected on all fractions, in particular b-GGT. In 5-6 days after there has been a gradual increase in total plasma GGT. Plasma f-GGT fraction shows minor alterations, while other fractions have a similar trend as total GGT. In bile sample T0 GGT is present mainly as b-GGT and in less extent as f-GGT. The first 24 h post-transplant bile b-GGT activity is decreased followed by a sudden increase in its activity with a peak observed in the fourth day while bile f-GGT fraction shows minimal changes. An increase of bile GGT activity and an apparent peak of f-GGT preceded by an abrupt drop in b-GGT activity a day before is observed at days 6 and 10 in two patients: and a reversal of the proportions between the bile b-and f-GGT fractions in favour of b-GGT fraction has been observed in one of these patient at day 10 (T10) and in another patient on days 7 (T7) and 8 (T8). All fractions behave as positive index of cholestasis and liver function. Interestingly all fractions showed a positive correlation with direct bilirubin apart from s1-GGT, which showed a strict negative correlation. Unexpectedly, all fractions were negative associated with LDH, and b-GGT and m-GGT showed a negative correlation also with transaminases AST and ALT. Thus plasma GGT fractions, in particular b-GGT and m-GGT, were primarily related to ischemic-type biliary lesions following liver transplantation. In conclusion the main findings of this study are: 1) patients with NAFLD and CHC display different GGT fraction patterns, despite similar total GGT activity values. 2) Collected data showed that the b/s ratio, independently of the absolute values of total GGT and its fractions, displays a high sensitivity and specificity for liver cirrhosis, and the values of the b/s ratio were lower than controls independently of the cause of the cirrhosis (viral or cryptogenetic) or the presence of associated liver cancer. This suggests that the b/s ratio is a specific biomarker of architectural and functional damage of the liver. 3) the elution profile of bile GGT activity showed the presence of only two forms corresponding to plasma fractions b-GGT and f-GGT, respectively. Similar to that found in plasma GGT fractions, the biliary f-GGT fraction consists of soluble protein and b-GGT fraction of exosomes. But, unlike plasma b-GGT, biliary b-GGT fraction is in part sensitive ti papain action; likely, the portion of biliary b-GGT sensitive to the proteolytic action might be consistuted of bile acids micelles. 4) Plasma b-GGT and m-GGT levels, in the first 10 days after liver transplant, were primarily related to ischemic-type biliary lesions following liver transplantation The precise nature of GGT fractions has not yet been established, and at present it is not possible to speculate on the possible reasons conducting to different GGT fraction patterns in NAFLD and CHC and cirrhosis. Data collected suggest that GGT fraction pattern specificity might depend on its ability to reflect the different extents of inflammatory, structural and functional derangement in liver disease. Further study on the nature and biological significance of plasma GGT fractions in health and disease might allow to improve the use of this sensitive but otherwise poorly specific biomarker in the numerous contexts in which it is employed, including multimarker algorithms comprising plasma GGT for the assessment of liver steatosis and fibrosis. Extensive investigation on the diagnostic value of GGT fractions might provide a novel diagnostic tool for liver diseases; understanding the nature, properties, and pathophysiological variations of GGT fraction pattern might allow a better understanding of the pathogenesis of the diseases associated with increased GGT