Gallbladder containing incisional hernia in an elderly woman

Key Clinical Message Gallbladder herniation is a rare phenomenon with risk factors of being female, older age, and previous history of hernias. Imaging modalities can confirm the diagnosis. Cholecystectomy and hernia repair to prevent strangulation may be warranted

Outcome of deep anterior lamellar keratoplasty with intraoperative Descemet membrane perforation

Purpose The aim of this study is to report the outcome of deep anterior lamellar keratoplasty (DALK) with intraoperative Descemet membrane (DM) perforation. Patients and methods A retrospective case series of all DALK cases performed from October 2015 to October 2021 at Alexandria Main University Hospital, Alexandria, Egypt, with and without intraoperative DM perforation was evaluated. The study included 110 eyes of 108 patients who met the inclusion criteria, had complete records, and at least 12 months of follow-up. They were further divided into four groups; DALK with intact DM, DALK with DM microperforation, DALK with DM macroperforation, and DALK converted to penetrating keratoplasty (PK). The best corrected visual acuity (BCVA), graft rejection, endothelial cell (EC) density, and complications were compared between the four groups. Results The most common surgical step during which DM perforation occurred was deep lamellar dissection (41 cases, 70.7%). At 12-month postoperatively, there was no statistically significant difference (P=0.087) in BCVA between the four studied groups (mean=0.33±0.19, 0.39±0.23, 0.45±0.39, and 0.32±0.34 LogMAR, respectively). The DALK groups had significantly less rate of graft rejection (P=0.009) and complications (P=0.006) compared to the PK group. The EC density was statistically significantly higher in the eyes with intact DM compared to the eyes with DM perforation (P<0.001) and to the eyes converted to PK (P<0.001). Interestingly, there was no statistically significant difference between the PK group and the DM macroperforation group in the EC density (P=0.243). Conclusion DALK, with or without DM perforation, has equivalent visual outcome, less graft rejection, and less complications compared to the cases converted to PK. The EC density in DALK with intact DM or DM microperforation was significantly higher than in DALK with DM macroperforation and DALK converted to PK

Chickpea (Cicer arietinum) steep liquor as a leavening agent: Effect on dough rheology and sensory properties of bread

Dough fermentation is one of the oldest process in food technologies. It has been recently intensively studied for its impact on the sensory, structural, nutritional and shelf life properties of leavened baked products. The goals of this work were to investigate chickpea steep liquor (CSL) as a dough-leavening agent and to study the effect of CSL on the dough rheology and sensory properties of leavened bread. CSL was prepared by submerging chickpea seeds in boiled distilled water (1:2, w/v) for 24 h at 37оC, and then obtained liquor was filtered and freeze-dried to obtain CSL. The addition of CSL to wheat flour (WF) brought changes in the dough mixing behavior as measured by the farinograph. An increase in the farinograph water absorption of WF dough was observed when 4.5% CSL and 1.5% yeast was added, while arrival time was not affected. Addition of CSL to the dough at a content of 4.5, 9.0 and 13.5 g CSL/300 g WF caused an increase in dough stability. The CSL addition also increased mechanical tolerance index, dough weakening and mixing time. Dough development time for all blends was higher than the control (1.2-1.5 min), while between the CSL samples no significant difference was observed. The loaf weight slightly increased from 146.2 g for control to 152.2 g for CSL fermented bread, whereas the loaf volume and specific volume of CSL-fermented bread were lower than the control. The combination of yeast and CSL increased the acceptability of bread with the increasing level of both leavening agents’. The results show that CSL could be used as an alternative to yeast for syngas fermentation. On the other hand, CLS is rich in nutrients and lower in cost compared to yeast

Combined femtosecond laser-assisted intracorneal ring segment implantation and corneal collagen cross-linking for correction of keratoconus

Osama Ibrahim,1 Ahmed Elmassry,1 Amr Said,1,2 Moones Abdalla,2 Hazem El Hennawi,1 Ihab Osman1 1Department of Ophthalmology, Alexandria University, Alexandria, Egypt; 2Roayah Vision Correction Center, Alexandria, Egypt Purpose: To assess the safety, predictability, and effectiveness of Keraring intrastromal corneal ring segments (ICRS) insertion assisted by femtosecond laser and corneal collagen cross-linking (CXL) for keratoconus correction. Patients and methods: In this prospective, noncomparative, and interventional case series, 160 eyes of 100 adult keratoconus patients with poor best-corrected visual acuity (BCVA) (less than 0.7) and intolerance to contact lens wear were included. Patients underwent femtosecond laser-assisted placement of ICRS and CXL. All patients were examined for a complete ophthalmological test: uncorrected visual acuity (UCVA), BCVA, spherical equivalent, keratometry (K1-flat and K2-steep), pachymetry, and Scheimpflug imaging with the Pentacam at 1 week and at 1, 3, and 6 months postoperatively. Results: At 6 months, a significant difference was observed (P&lt;0.001) in mean UCVA and BCVA from 0.92&plusmn;0.677 and 0.42&plusmn;0.600 logMAR preoperatively to 0.20&plusmn;0.568 and 0.119&plusmn;0.619 logMAR, respectively. Mean spherical equivalent refractions were significantly lower (P&lt;0.001) at 6 months. Mean keratometry (K) also significantly reduced (P&lt;0.001) from 50.93&plusmn;5.53 D (K1-flat) and 55.37&plusmn;5.76 D (K2-steep) to 47.32&plusmn;4.61 and 51.08&plusmn;5.38 D, respectively. In terms of pachymetry, no significant difference was observed preoperatively versus postoperatively (P=1.000). Conclusion: Keraring ICRS insertion assisted by femtosecond laser and corneal CXL provided significant improvement in visual acuity, spherical equivalent, and keratometry, which suggests that it may be effective, safe, and predictable for keratoconus correction. Keywords: keratometry, pachymetry, keratectesia, Pentacam, irregular astigmatis

Metabolites profiling reveals gut microbiome-mediated biotransformation of green tea polyphenols in the presence of N-nitrosamine as pro-oxidant

The gut microbiome contributes to host physiology and nutrition metabolism. The interaction between nutrition components and the gut microbiota results in thousands of metabolites that can contribute to various health and disease outcomes. In parallel, the interactions between foods and their toxicants have captured increasing interest due to their impact on human health. Taken together, investigating dietary interactions with endogenous and exogenous factors and detecting interaction biomarkers in a specific and sensitive manner is an important task. The present study sought to identify for the first time the metabolites produced during the interaction of diet-derived toxicants e.g., N-nitrosamines with green tea polyphenols, using liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS). In addition, the metabolic products resulting from the incubation of green tea with a complex gut microbiome in the presence of N-nitrosamine were assessed in the same manner. The quinone products of (epi)catechin, quercetin, and kaempferol were identified when green tea was incubated with N-nitrosamine only; whereas, incubation of green tea with N-nitrosamine and a complex gut microbiome prevented the formation of these metabolites. This study provides a new perspective on the role of gut microbiome in protecting against potential negative interactions between food-derived toxicants and dietary polyphenols

Expression of Programmed Death Ligand-1 and Correlation with Clinicopathological Features and CD8 Infiltration in Breast Cancer

Abstract Background: Breast cancer (BC) is considered one of the most diversified types of tumors, characterized by a high mutational burden in the tumor milieu and a lack of immune cell makeup. The programmed death receptor-1 (PD -1)/programmed death ligand-1 (PD -L1) axis has been identified as a new target in the field of immunotherapy because, when activated, they worsen the future scenarios of the disease by helping tumor cells (TC) to escape immune surveillance. This study aims to investigate the expression of PD-L1 in BC tissues from Sudanese ladies and correlate its expression with clinicopathological features and the infiltration of CD8+T lymphocytes by immunohistochemistry (IHC). Methods: One hundred and fifty archived BC blocks were collected from National Public Health Laboratory from January 2019 to August 2020. Data regarding age, TNM staging, grade, and hormonal status were considered. Tissue sections were examined using IHC to determine the expression of PD-L1 and CD8. Results: Among one hundred and fifty BC samples, 73 (48.7%) were TNBCs, and 77 (51.3%) were hormone-positive BCs. PD-L1 was significantly associated with BC subtypes, especially TNBCs (P = 0.001), a similar significant association was shown with CD8 infiltration (P = 0.006). None of the clinicopathological features were associated with PD-L1 expression. Conclusion: PD-L1 expression is strongly associated with TNBC's and linked to CD8+ cells infiltration to the tumor milieu. Moreover, no correlation has been observed between the expression of PD-L1 and clinicopathological features in this study

During bacteremia, Pseudomonas aeruginosa PAO1 adapts by altering the expression of numerous virulence genes including those involved in quorum sensing.

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that produces numerous virulence factors and causes serious infections in trauma patients and patients with severe burns. We previously showed that the growth of P. aeruginosa in blood from severely burned or trauma patients altered the expression of numerous genes. However, the specific influence of whole blood from healthy volunteers on P. aeruginosa gene expression is not known. Transcriptome analysis of P. aeruginosa grown for 4 h in blood from healthy volunteers compared to that when grown in laboratory medium revealed that the expression of 1085 genes was significantly altered. Quorum sensing (QS), QS-related, and pyochelin synthesis genes were downregulated, while genes of the type III secretion system and those for pyoverdine synthesis were upregulated. The observed effect on the QS and QS-related genes was shown to reside within serum fraction: growth of PAO1 in the presence of 10% human serum from healthy volunteers significantly reduced the expression of QS and QS-regulated genes at 2 and 4 h of growth but significantly enhanced their expression at 8 h. Additionally, the production of QS-regulated virulence factors, including LasA and pyocyanin, was also influenced by the presence of human serum. Serum fractionation experiments revealed that part of the observed effect resides within the serum fraction containing <10-kDa proteins. Growth in serum reduced the production of many PAO1 outer membrane proteins but enhanced the production of others including OprF, a protein previously shown to play a role in the regulation of QS gene expression. These results suggest that factor(s) within human serum: 1) impact P. aeruginosa pathogenesis by influencing the expression of different genes; 2) differentially regulate the expression of QS and QS-related genes in a growth phase- or time-dependent mechanism; and 3) manipulate the production of P. aeruginosa outer membrane proteins

Geranylgeraniol and Green Tea Polyphenols Mitigate Negative Effects of a High-Fat Diet on Skeletal Muscle and the Gut Microbiome in Male C57BL/6J Mice

Natural bioactive compounds are proposed as alternatives in mitigating obesity-associated skeletal muscle dysfunction. The objective of this study was to test the hypothesis that the combination of geranylgeraniol (GGOH) and green tea polyphenols (GTPs) can alleviate high-fat-diet (HFD)-induced muscle atrophy and alter gut microbiome composition. Male C57BL/6J mice fed an HFD were assigned to four groups (12 mice each) in a 2 (no GGOH vs. 400 mg GGOH/kg diet) &times; 2 (no GTPs vs. 0.5% weight/volume GTPs in water) factorial design. After 14 weeks of diet intervention, skeletal muscle and cecal samples were collected and examined. Compared to the control groups, the group that consumed a combination of GGOH and GTPs (GG + GTPs) had significantly decreased body and fat mass but increased skeletal muscle mass normalized by body weight and cross-sectional area. In soleus muscle, the GG + GTP diet increased citrate synthase activity but decreased lipid peroxidation. Gut microbiome beta-diversity analysis revealed a significant difference in the microbiome composition between diet groups. At the species level, the GG + GTP diet decreased the relative abundance of Dorea longicatena, Sporobacter termitidis, and Clostridium methylpentosum, and increased that of Akkermansia muciniphila and Subdoligranulum variabile. These results suggest that the addition of GGOH and GTPs to an HFD alleviates skeletal muscle atrophy, which is associated with changes in the gut microbiome composition

Clinical validation of the automated characterization of cone size and center in keratoconic corneas

PURPOSE: To evaluate an automated method for detecting the cone shape characteristics and to assess the cornea specialists' subjective variability of these measures using different maps. METHODS: Topographic images of the anterior and posterior surface of each eye were presented to 12 clinicians in two different types of map: Tangential curvature and relative elevation to the best-fit sphere. They were asked to mark the cone center and its boundaries in the two maps without knowing that they belonged to the same patient. The results between the maps were compared to assess the subjective variability dependent on the map type and the automated method was compared against both estimations to assess its accuracy. RESULTS: Considering the results of anterior and posterior surfaces, there was low agreement between the cone center estimations using different types of maps for 10 of the 12 cases (P .05). There was high variability, up to 55%, among clinicians' estimations of the cone area. The results of the automated method were within the range of the expert's estimations. CONCLUSIONS: An objective, mathematically derived method of determining morphological dimensions of the cone was consistent with clinicians' evaluations. Although there was high variability among the experts' subjective estimates, which were highly influenced by the type of map, the objective method provided a reliable evaluation of the keratoconus shape independent of maps or color scale