Clinical and echocardiographic evaluation of patients undergoing total leaflets preservation during mitral valve replacement; Does it make a difference?

Background: The effect of anterior and posterior leaflet preservation on left ventricular function after mitral valve replacement is still the subject of ongoing research. The objective of this study is to analyze the early outcomes of total leaflets preservation compared to posterior and non-leaflet preservation during mitral valve surgery on cardiac function and dimensions measured by echocardiography and on the clinical outcomes.Methods: This prospective cohort study recruited 155 patients who had mitral valve replacement (MVR) from April 2016 to March 2018 at Assiut University Hospital. Patients were divided into three groups according to the technique of leaflets preservation; Group I (no leaflet preservation-N-MVR), Group II (total leaflet preservation- T-MVR) and Group III (posterior leaflet preservation-P-MVR). Patients who underwent redo mitral valve replacement (MVR) or those with endocarditis and had combined coronary artery bypass grafting with the MVR were excluded from the study.Results: There were nine early deaths (6%); eight patients were in Group I (N-MVR). Causes of mortality were massive intracranial hemorrhage (n= 2) and left ventricular failure (n=6). One patient died in Group III (P-MVR) from intracranial hemorrhage (1.3%). Hospital stay was significantly longer in N-MVR group compared to T-MVR and P-MVR (10.6±2.13 days in N-MVR group; p= 0.03 and 0.011 respectively). Postoperative low cardiac output occurred in all patients in N-MVR group. Left ventricular function (ejection fraction= 61.28±6.02%) and dimensions (end-diastolic diameter= 5.18±0.69 mm, end-systolic diameter= 3.58±0.78 mm) improved significantly in total leaflets preservation group.Conclusion: Leaflet preservation during mitral valve replacement was associated with improved clinical and echocardiographic outcomes. Non-leaflets preservation increased the risk of postoperative complications and length of hospital stay. Leaflet preservation is recommended as the standard approach during mitral valve replacement

Vascular complications in adults and pediatrics live-donor renal transplantation: 3 decades of single centre experience

We analyzed the incidence of vascular complications in adults and pediatrics live donor renal transplantations over 3 decades and compared its impact upon patient and graft survival in both groups.Material and methods: Between March 1976 and December 2005, 1785 live-donor renal transplantswere performed in a single institute, of the 1546 adults and 239 pediatric (age ≤18 years). The incidence of different types of vascular complications were determined in both groups. Long term patient and graft survival in patients with or without vascular complications and in various types of vascular complications were calculated & compared in both groups.Results: The overall incidence of vascular complications was 2.9%, it was equally 2.9% in both groups. In adults, 46 complications in 45 patients included 16 arterial, 10 renal artery thrombosis (0.6%), 2 cases of spasm in renal artery(0.1%), renal artery stenosis in 5 (0.3%), renal vein thrombosis in one (0.06%) and hemorrhagic complications in 28 patients whereas there were no thrombotic complications in the pediatric group, 6 case of hemorrhage (2.5%) and one case of renal artery stenosis (0.4%). There is steady decrease of vascular complications over the last 3 decades. The vascular complications significantly adverse patient and graft survival in both groups (p<0.001). The 5-years patient and graft survival in adults and pediatrics with or without vascular complications were 59.5 ± 9.2%, 89.14 ± 0.89%, 57.5 ± 18.7% and 90.18 ± 2.2% for the patient and 40.14 ± 7.75%, 97.79 ± 1.14%, 28.57 ± 17.07% and 77.18 ± 3.02% for the graft. There is no statistical significant difference in either patient or graft survival in thrombotic, stenotic or hemorrhagic complications in adult or hemorrhagic complications in the pediatric group (p=0.22 and p=0.142 respectively).Conclusions: There is no increase in incidence of vascular complications in pediatrics than adult transplants. The survival either graft or patient is comparable between adult and pediatric with or without vascular complications and the subgroups of vascular complications

The Effect of Anterior Stromal Puncture Using Q-Switched Nd:YAG Laser on Corneal Wound Healing

Introduction: Recurrent corneal erosion occurs when the wounded corneal epithelium failed to adhere to the underlying stroma. Therefore, this work aimed to assess the effect of treatment of corneal injury using Q- switched Nd:YAG laser.  Method: Twenty one New Zealand male rabbits weighing 2-2.5 kg and 3 months old were classified into three main groups. The control group: did not received any treatment (n=3 rabbits). The rest of the animals (n= 18 rabbits), corneal epithelium was injured by syringe needle and blade 15 and divided into:(A) Normal healing group: which was divided into three subgroups (n=3 rabbits each), and the animals were left for normal healing for1 day, 1 week, and 4 weeks respectively, (B) Laser treated group: divided into three subgroups (n=3 rabbits each) and subjected to anterior stromal puncture using Q-switched Nd: YAG laser on corneal sub-epithelium or superficial stroma, and the animals were left for 1 day, 1 week, and 4 weeks respectively. After the demonstrated periods, the corneas were isolated for estimation of total protein content, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), total antioxidative capacity (TAC), total oxidative capacity (TOC) and oxidative stress index (OSI).Results: The present results of corneal total protein showed increment in the percentage change in normal healed groups after 1 day, 1 week and 4 weeks by values of 93%, 68% and 39%. In Q-switched Nd: YAG laser treated group the results showed better improvement in corneal protein than normal healed group with percentage changes of 58%, 29%, and 7.5% respectively. In SDS- PAGE, a protein band at 110 KD appeared in the migrating epithelium for both normal healed group and Q-switched Nd:YAG laser treated group with changes in the peaks intensities at middle and  low molecular weight regions. Moreover, after 4 weeks the peak at 110 KD disappeared in the wounded epithelium treated with Q-switched Nd:YAG. After four weeks, the OSI in laser treated corneas showed pronounced balance between antioxidative capacity and oxidative capacity.Conclusion: Anterior stromal puncture by Q-switched Nd:YAG laser is an effective, simple, safe and promising procedure to treat recurrent corneal erosion than normal healing

GEOCHEMISTRY, URANIUM, THORIUM AND RARE EARTH ELEMENTS OF TRACHYTE DYKES OF UMM SALATIT MOUNTAIN AREA, CENTRAL EASTERN DESERT, EGYPT

Umm Salatit Mountain area is a part of the Central Eastern Desert of Egypt. It is composed of ophiolitic mélange, older granitoids, biotite granites, muscovite granites and post granitic dykes and veins. Purpose of the work. The present work deals with the detailed investigations of the geology, petrography, geochemistry and spectrometric prospecting of the studied trachyte dykes as a possible source of uranium mineralization. Research methods. This work involves both field work (Construction of geological map with the structural features, scale 1 : 50,000, Spectrometric measurements of the different rock units using a portable gamma-ray spectrometer RS-230) and laboratory work (preparation of thin sections for petrographic studies by polarizing microscope), Atomic Emission Spectroscopy (AES), and Mass-Spectrometer with Inductively Coupled Plasma (ICPMS). Results. Petrographically, trachyte dykes consist mainly of K-feldspar with relatively minor amount of plagioclase, iron oxides, quartz and biotite. Secondary minerals are represented by sericite, muscovite, chlorite, carbonates and epidote. Accessory minerals are represented by opaque minerals. Trachytic textures are the main characteristic feature in trachyte. Geochemically, the investigated trachyte dykes were originated from an alkali magmarich in total alkalis, and the tectonic setting is continental basalt. Trachyte dykes have steep LREEs, nearly flat HREEs and a negative Eu anomaly. The negative Eu anomaly is either due to the partitioning of Eu into feldspar during fractionation, which is an important process in developing alkalinity, or the presence of residual feldspar in the source. Another alternative explanation for the negative Eu anomaly is based on the high oxygen fugacity in the melt due to volatile saturation. In general, all trachyte samples show moderate enrichment of most large ion lithophile elements (LILE) and high field strength elements (HFSE) and depletion of P, Ti and K. The depletion of Ti and p is ascribed to fractionation of titanomagnetite and apatite. The determination of equivalent uranium, thorium (ppm), potassium % and dose rate (m Sv/y) radiometrically by using portable RS-230 indicates that the dose rate in the trachyte dykes ranges from 0.5 to 1.5 with an average of 1.2 (m Sv/y). The radiometric data of the radioelements for them show a wide variation in eU and eTh contents. The eU content ranges from 2 to 14 ppm with an average of 6.6 ppm and the eTh content ranges from 4 to 37 ppm with an average of 18.03 ppm. Both U and Th correlate similarly with other major and trace elements, reflecting their geochemical coherence during the crystallization of the magma