Minimally invasive surgery for ovarian cysts in children: transumbilical versus laparoscopic approach

Background/purpose A transumbilical approach was recently reported for management of several surgical procedures in children. The aim of this study was to evaluate the feasibility and safety of a minimally invasive transumbilical approach against the laparoscopic approach in the management of ovarian cysts in children.Patients and methods This prospective study was conducted at Tanta University Hospital and at affiliated hospitals from April 2005 to May 2011. A total of 21 patients aged between 2 days and 8 years with ovarian cysts were included. Patients were randomly divided into two groups: group 1 (n= 11) underwent the transumbilical approach, whereas group 2 (n= 10) were treated by laparoscopy. Patients were evaluated with respect to operative time, need to convert to open surgery or to increase umbilical incision, any intraoperative and/or postoperative complication, total hospital stay, and final cosmetic outcome.Results The ovarian cysts were simple, not complicated, and larger than 5cm in 12 patients. Mixed cystic and solid parts were present in three patients. In another six patients, the cysts were complicated by torsion (n=4) or by hemorrhage inside the cysts (n= 2). The mean size of the ovarian cysts was not statistically significant in either group (8.2 cm in group 1 vs. 7.8cm in group 2). The mean operative time was shorter in group 1 compared with that in group 2 (45 ±12 vs. 55 ±10 min). Extension of umbilical incision was needed in one patient in group 1 and in another two patients in group 2 (site of the umbilical port) for the extraction of ovarian cysts containing a solid tumor inside. Duration of hospital stay was comparable in both groups (1–2 days in both groups). No significant intraoperative or postoperative complications were recorded in both groups. Likewise, the cosmetic outcome was excellent in both groups.Conclusion Both the transumbilical and laparoscopicapproaches are feasible and safe for treatment of ovarian cysts in children. The results of both approaches are comparable. The transumbilical approach seems to be an attractive alternative for managing ovarian cysts in children in the absence of appropriate settings for laparoscopy.Keywords: children, laparoscopy, neonates, ovarian cyst, torsion, transumbilical approac

Development of a Subunit Vaccine Against Bovine Diarrhea Caused by K99 Enterotoxigenic Escherichia coli and Bovine Viral Diarrhea Virus

Bovine diarrhea is economically one of the most important problems in cattle industry. Enterotoxigenic Escherichia coli (ETEC), particularly strains expressing K99 (F5) fimbriae and heat-stable type I (STa) enterotoxin is the predominant bacterial cause of diarrhea in calves; whereas bovine viral diarrhea virus (BVDV) causes diarrhea and other illness to cattle at all ages. A vaccine that prevents against both K99 fimbrial ETEC and BVDV could benefit greatly to cattle producers worldwide. We hypothesized that a novel multivalent vaccine composed of K99, STa and BVDV E2 antigens could induce immunity for broad protection against bovine diarrhea. In this study we applied FanC, the major fimbrial subunit of K99, as a backbone to have a STa toxoid and the most immunogenic E2 epitopes embedded to construct ‘FanC-STa-E2’ fusion antigen, and examined this ‘FanC-STa-E2’ fusion antigen for immunity against ETEC and BVDV in a murine model for vaccine potential assessment. Adult female BALB/C mouse intraperitoneal (i.p.) immunized with 200 μg purified antigen with equal volume of adjuvant. Developed systemic and mucosal immune responses to K99, STa, and BVDV E2. Moreover, those antibodies showed abilities to block the E. coli K99 bacterial adhesion by K99-receptor positive INT-407 and IPEC-J1 cells, neutralized the STa enterotoxin, and also neutralized the BVDV infection. This suggests that this fusion antigen has the potential to be developed as a broadly protective vaccine against bovine diarrhea

Human Gut Microbiota and Parkinson\u27s Disease in an Egyptian Population

Multiple lines of evidence suggest the role of the gut microbiome in the predisposition and progression of Parkinson’s disease. This present cross-sectional study was performed to compare the composition of the gastrointestinal microbiota in patients with Parkinson\u27s disease to their counterparts. Stringent inclusion criteria were followed to reliably identify our target population. Parkinson’s patients (n = 40) along with reference subjects (n = 39) were recruited from November 2021 to August 2022. Detailed demographic and clinical data were obtained at baseline using a set of questionnaires and clinical assessment tools. Fecal specimens were collected from all participants, and gut commensals were characterized using 16S rRNA gene amplicon sequencing. The endpoint was to discern the disparities in the gut microbiota structure. Our results demonstrate no significant difference at the taxonomic level between Parkinson\u27s patients and the reference group. However, marginally significant species associated with intestinal inflammation, gut permeability, and mitochondrial dysfunction were reported. These recent findings create an opportunity for further studies comprising a bigger sample size and using higher resolution sequencing techniques in aims to better understand whether and to what extent gut microbiota alterations play a role in the disease pathogenesis

Posterior sagittal rectopexy in the treatment of recurrent rectal prolapse in children Amel Abd

Background/purpose Several surgical techniques have been described to treat recurrent rectal prolapse in children after failure of initial surgical treatment. The aim of this study was to evaluate the safety and efficacy of posterior sagittal rectopexy (PSR) in children with recurrent rectal prolapse.Patients and methods Twenty-two patients aged between 1 and 7 years presented with recurrent rectal prolapse after failure of initial surgical treatment. Conservative management was successful in four cases. Eighteen were treated with PSR. The procedure included plication of the dilated rectum and fixation of the rectum to the sacrum. The follow-up ranged between 4 and 18 months.Results Superficial wound infection occurred in two cases, and both healed without any further consequences. Constipation improved in seven out of 12 patients, who had history of constipation before surgery. Partial mucosal prolapse recurrence occurred in three patients. Two improved conservatively after 5 months and 7 months, respectively, and one required mucosal trimming. Normal anorectal continence was noted in all patients older than 3 years at follow-up.Conclusion PSR is a good option in cases of recurrent rectal prolapse in children. The technique is both safe and effective. It is associated with satisfactory functional results.Keywords: children, complications, posterior sagittal rectopexy, rectal prolapse, recurren

Studies of Reaction Mechanisms in Organic Chemistry Using Radiochemical Techniques

An investigation of the mechanism of dehydrogenation of a hydroaromatic compound, 1:4,dihydronaphthalene, by a quinone, tetrachloro-1:4,benzoquinone, has been made. The reaction has been studied by kinetic measurements, spectroscopic measurements and by the determination of tritium isotope effects. The measurements were carried out at 80 C and phenetole was used as the solvent for the reaction mixture. In previous work in these types of systems second order kinetics are generally observed and the bulk of the experimental evidence suggests that the reaction proceeds by an ionic rather than a free radical mechanism. Transfer of a hydride ion has been postulated as the rate determining step. The present work does not entirely support this viewpoint; second order kinetics were only observed in the later stages of the reaction and in the initial reaction period the kinetic data suggest the mechanism is more complex than has previously been supposed. In addition, during the time over which the reaction was normally followed, i. e. 120 minutes, the amount of naphthalene formed is equivalent to approximately half of the 1:4,dihydronaphthalene consumed. The isotope effect measurements, using partially tritiated 1.4,dihydronaphthalene, have given a value of kT/k. =1.16+/-0.16. This result does not support the view that fission of the carbon-hydrogen bond is the rate-determining step, i. e. hydride ion transfer. The result is interpreted in terms of the first step in the reaction being the establishment of an equilibrium involving the formation of a charge-transfer complex and the value of k T/k greater than unity results from an inverse secondary isotope effect. The spectroscopic measurements prove the existence of charge-transfer complexes in the reaction mixture and indicate that the formation of these complexes is the initial step in the reaction. The extra consumption of 1:4,dihydronaphthalene in the reaction is ascribed to the formation of a chloro-substituted quinone in which a chlorine is replaced by monohydronaphthalene group. This byreaction would lead to the production of hydrogen chloride and the latter has been detected among the reaction products. It has been observed that significant amounts of hydrogen chloride do have a small catalytic effect on the reaction. The present work suggests that the reaction proceeds by an ionic mechanism but modifications in the earlier schemes are required. The following scheme is suggested for the reaction of the hydroaromatic compound (RH2) with the tetrachloroquinone (QCL4): RH2 + QCL4 ↔ charge-transfer complex (1) CT complex → RH+ + QCL4H- (2) RH+ + QCL4H-→ R + QCL4H2 (3) or CT complex → RHQCL3 + HCl (4) In systems where the quinone has a low redox potential, or where there is substantial steric hindrance, the formation of the charge transfer complex, step (1), can be rate determining, while with quinones of high redox potential step (1) is relatively rapid and step (2) is the rate determining step

Perineal trauma in children: a standardized management approach

Background/purpose The management of perineal trauma in children is very challenging in the absence of a well-defined institutional management protocol. The purpose of this study was to evaluate the result of implementing a standardized therapeutic approach to perineal trauma in children in our institution.Patients and methods This is a prospective study on the management of perineal trauma in children, according to a predefined protocol. Thirty-four patients with perineal trauma were treated at the Tanta University Hospital and affiliated hospitals during the period May 2003–July 2010. Two patients died of associated head trauma and other concomitant injuries. After initial assessment, resuscitation, and treatment of any existing life threatening condition, the patients were treated either by primary repair of all perineal soft tissue injuries without colostomy (group 1, n=16), primary perineal repair with covering colostomy (group 2, n=11), or fecal diversion and wound drainage with delayed sphincter repair if needed (group 3, n=5). Each patient was assigned to a particular management depending on the presence or absence of full-thickness anorectal injuries, anorectal lacerations, degree of wound contamination, and/or significant skin loss. All patients were evaluated with regard to the type of trauma, physical findings, management, postoperative wound infection or disruption, postoperative functional outcome, and cosmetic results.Results The ages ranged from 2 to 14 years. Significant wound infection occurred in three patients (one in each group), moderate-to-mild wound infection occurred in another four patients, partial wound disruption occurred in two patients in group 1. Urethral stricture occurred in two patients, who were treated by repeated dilatation. Vaginal stenosis developed in one patient. Anorectal continence was noted in 25 (80.6%) of 31 patients who were older than 3 years during the last follow-up visit.Conclusion (i) The proposed simple algorithm for the management of perineal trauma in children has facilitated decision making in the emergency room. (ii) Primary repair of the anorectal sphincter and other injured soft tissue with or without covering colostomy is recommended. (iii) Fecal diversion without sphincter repair should be reserved to cases with significant anorectal lacerations associated with gross contamination.Keywords: children, colostomy, perineal trauma, primary repai

Mutation analysis of dynamically typed programs

The increasing use of dynamically typed programming languages brings a new challenge to software testing. In these languages, types are not checked at compile-time. Type errors must be found by testing and in general, programs written in these languages require additional testing compared to statically typed languages.Mutation analysis (or mutation testing) has been shown to be effective in testing statically (or strongly) typed programs. In statically typed programs, the type information is essential to ensure only type-correct mutants are generated. Mutation analysis has not so far been fully used for dynamically typed programs. In dynamically typed programs, at compile-time, the types of the values held in variables are not known. Therefore, it is not clear if a variable should be mutated with number, Boolean, string, or object mutation operators.This thesis investigates and introduces new approaches for the mutation analysis of dynamically typed programs. The first approach is a static approach that employs the static type context of variables to determine, if possible, type information and generate mutants in the manner of traditional mutation analysis. With static mutation there is the danger that the type context does not allow the precise type to be determined and so type-mutations are produced. In a type-mutation, the original and mutant expressions have a different type. These mutants may be too easily killed and if they are then they represent incompetent mutants that do not force the tester to improve the test set. The second approach is designed to avoid type-mutations. This approach requires that the types of variables are discovered. The types of variables are discovered at run-time. Using type information, it is possible to generate only type-correct mutants. This dynamic approach, although more expensive computationally, is more likely to produce high quality, difficult to kill, mutants