Posttransplant Lymphoproliferative Disorders

Posttransplant lymphoproliferative disorders (PTLDs) are a group of diseases that range from benign polyclonal to malignant monoclonal lymphoid proliferations. They arise secondary to treatment with immunosuppressive drugs given to prevent transplant rejection. Three main pathologic subsets/stages of evolution are recognised: early, polymorphic, and monomorphic lesions. The pathogenesis of PTLDs seems to be multifactorial. Among possible infective aetiologies, the role of EBV has been studied in depth, and the virus is thought to play a central role in driving the proliferation of EBV-infected B cells that leads to subsequent development of the lymphoproliferative disorder. It is apparent, however, that EBV is not solely responsible for the “neoplastic” state. Accumulated genetic alterations of oncogenes and tumour suppressor genes (deletions, mutations, rearrangements, and amplifications) and epigenetic changes (aberrant hypermethylation) that involve tumour suppressor genes are integral to the pathogenesis. Antigenic stimulation also plays an evident role in the pathogenesis of PTLDs. Plasmacytoid dendritic cells (PDCs) that are critical to fight viral infections have been thought to play a pathogenetically relevant role in PTLDs. Furthermore, regulatory T cells (Treg cells), which are modulators of immune reactions once incited, seem to have an important role in PTLDs where antigenic stimulation is key for the pathogenesis

Dexmedetomidine as an adjuvant to bupivacaine in ultrasound fascia iliaca compartment block in proximal end femur surgeries

Background: Fracture neck femur is a common cause of hospital admission among the elderly population. Many patients admitted with fracture femur have long-standing cardiac, hepatic or renal problems. This makes a challenge to balance adequate analgesia with side effects of opioids. Fascia iliaca compartment block (FICB) is one of the peripheral nerve block techniques. It became widely used in providing postoperative analgesia for patient with fracture neck femur either in emergency department or in the operating room.Objective: To evaluate the efficacy of addition of dexmedetomidine to bupivacaine on the duration and quality of postoperative analgesia in ultrasound guided fascia iliaca compartment block in proximal end femur surgeries.Patients and methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I - II of both sexes aged from 20-60 years scheduled for proximal end femur surgeries. They were randomly assigned to one of two equal groups (n=30 each), using closed envelope technique: Bupivacaine group (B group), and Bupivacaine + dexmedetomidine (BD group). Result: Our study demonstrated prolongation of postoperative analgesia in bupivacaine-dexmedetomidine group (BD) compared to bupivacaine group (B). It showed statistically significant reduction in cumulative pethidine doses and prolongation in the time till first rescue analgesic is required in the BD group in comparison with the B group in the first 24 hours. Hemodynamic changes and incidence of side effects, were statistically insignificant among the two groups. Conclusion: Addition of dexmedetomidine, as an adjuvant to the local anesthetic bupivacaine, in ultrasound fascia iliaca compartment block provides prolongation of the duration of postoperative analgesia with less opioid consumption without remarkable side effects

Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

AbstractPurposeTo determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.Patients and methodsA total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.ResultsElectrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11mm2 was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.ConclusionMedian nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group compared to the conventional SSF group (3 stage improvement from baseline in SS/ST-F group versus 2 stage improvement only in conventional SSF group).Conclusions: This pilot study provides a modified sacrospinous sacrotuberous ligament colpopexy technique which is easier to be performed and mastered, does not need the use of special devices, provides better improvement of grade of prolapse and less complications compared to the conventional technique.

Biochemical Characterization, Antifungal Activity, and Relative Gene Expression of Two Mentha Essential Oils Controlling Fusarium oxysporum, the Causal Agent of Lycopersicon esculentum Root Rot

Tomato (Lycopersicon esculentum Mill.) is important food in daily human diets. Root rot disease by Fusarium oxysporum caused huge losses in tomato quality and yield annually. The extensive use of synthetic and chemical fungicides has environmental risks and health problems. Recent studies have pointed out the use of medicinal plant essential oils (EOs) and extracts for controlling fungal diseases. In the current research, Mentha spicata and Mentha longifolia EOs were used in different concentrations to control F. oxysporum. Many active compounds are present in these two EOs such as: thymol, adapic acid, menthol and menthyl acetate. These compounds possess antifungal effect through malformation and degradation of the fungal cell wall. The relative expression levels of distinctly upregulated defense-related WRKY genes (WRKY1, WRKY4, WRKY33 and WRKY53) in seedling root were evaluated as a plant-specific transcription factor (TF) group in different response pathways of abiotic stress. Results showed significant expression levels of WRKY, WRKY53, WRKY33, WRKY1 and WRKY4 genes. An upregulation was observed in defense-related genes such as chitinase and defensin in roots by application EOs under pathogen condition. In conclusion, M. spicata and M. longifolia EOs can be used effectively to control this plant pathogen as sustainable and eco-friendly botanical fungicides

Green Synthesized of Thymus vulgaris Chitosan Nanoparticles Induce Relative WRKY-Genes Expression in Solanum lycopersicum against Fusarium solani, the Causal Agent of Root Rot Disease

: Fusarium solani is a plant pathogenic fungus that causes tomato root rot disease and yield losses in tomato production. The current study's main goal is testing the antibacterial efficacy of chitosan nanoparticles loaded with Thyme vulgaris essential oil (ThE-CsNPs) against F. solani in vitro and in vivo. GC-MS analysis was used to determine the chemical constituents of thyme EO. ThE-CsNPs were investigated using transmission electron microscopy before being physicochemically characterized using FT-IR. ThE-CsNPs were tested for antifungal activity against F. solani mycelial growth in vitro. A pot trial was conducted to determine the most effective dose of ThE-CsNPs on the morph/physiological characteristics of Solanum lycopersicum, as well as the severity of fusarium root rot. The relative gene expression of WRKY transcript factors and defense-associated genes were quantified in root tissues under all treatment conditions. In vitro results revealed that ThE-CsNPs (1%) had potent antifungal efficacy against F. solani radial mycelium growth. The expression of three WRKY transcription factors and three tomato defense-related genes was upregulated. Total phenolic, flavonoid content, and antioxidant enzyme activity were all increased. The outfindings of this study strongly suggested the use of ThE-CsNPs in controlling fusarium root rot on tomatoes; however, other experiments remain necessary before they are recommended

A Proposed Vision of the Transformation of the Arab Universities into Smart Digital Universities

This research develops a proposed vision to transform Arab universities into smart digital universities. The descriptive research approach is used to achieve the research objectives. The research sample consists of 450 faculty members and 75 educational experts randomly selected by stratified random method. The questionnaire is adopted as a research instrument. The findings indicate that a proposed vision can be developed to transform Arab universities into smart digital universities by addressing several themes; the philosophical premises of the proposed vision, the features of the proposed vision “smart university administration, smart people, smart university environment, and knowledge network”, determining the requirements necessary to implement the proposed vision, setting the appropriate foundations for the proposed implementation and success in Arab universities, and demonstrating the potential challenges and threats that may stand in the way of implementing the proposed vision and methods to overcome them

Loss of MANF Causes Childhood-Onset Syndromic Diabetes Due to Increased Endoplasmic Reticulum Stress

Mesencephalic astrocyte-derived neurotrophic factor (MANF) is an endoplasmic reticulum (ER)-resident protein that plays a crucial role in attenuating ER stress responses. Although MANF is indispensable for the survival and function of mouse beta-cells, its precise role in human beta-cell development and function is unknown. In this study, we show that lack of MANF in humans results in diabetes due to increased ER stress, leading to impaired beta-cell function. We identified two patients from different families with childhood diabetes and a neurodevelopmental disorder associated with homozygous loss-of-function mutations in the MANF gene. To study the role of MANF in human beta-cell development and function, we knocked out the MANF gene in human embryonic stem cells and differentiated them into pancreatic endocrine cells. Loss of MANF induced mild ER stress and impaired insulin-processing capacity of beta-cells in vitro. Upon implantation to immunocompromised mice, the MANF knockout grafts presented elevated ER stress and functional failure, particularly in recipients with diabetes. By describing a new form of monogenic neurodevelopmental diabetes syndrome caused by disturbed ER function, we highlight the importance of adequate ER stress regulation for proper human beta-cell function and demonstrate the crucial role of MANF in this process.Peer reviewe