ETS-1 oncoprotein expression is decreased in aggressive papillary transitional cell carcinoma of the urinary bladder: An immunohistochemical study

Introduction: ETS-1 proto-oncogene is a transcription factor that plays multiple roles in the process of oncogenesis and helps in the process of tumor invasion. ETS-1 oncoprotein correlation with high grade and invasive tumors is controversial; as it is found to be upregulated with some tumors and down regulated with others. Expression of ETS-1 in urinary bladder carcinoma (UBC) and its correlation with tumor differentiation and invasiveness are still under-investigated. So far, there is no reliable prognostic marker has been proved for detection of the tumor progression and recurrence.Objectives: To analyze the correlation between ETS-1 oncoprotein immunohistochemical expression and the different stages and grades of the primary papillary transitional cell carcinoma of the urinary bladder.Patients and methods: This is a retrospective cross sectional study that included archival material from 150 cancer cases and 24 control biopsies.Results: There was a decreased ETS-1 oncoprotein expression with increasing stage and grade of the tumor with a highly significant statistical correlation (P = 0.001). With the quantitative assessment of the immunohistochemical results and using ROC (receiver operating characteristics) curve, cut-off values were found, that were associated with high grade and muscle invasive tumors (≤30% and ≤20%, respectively).Conclusion: ETS-1 oncoprotein is down regulated with high grade and highly invasive urinary bladder papillary transitional cell carcinomas. This oncoprotein may be used as an independent prognostic marker to predict the aggressive papillary transitional carcinomas with high invasive potential. More studies are needed to confirm our results.Keywords: Papillary transitional cell carcinoma; ETS-1; Prognostic marker; Immunohistochemical; Stage; Grad

Neurological disorders in HIV:Hope despite challenges

INTRODUCTION: Human Immunodeficiency virus (HIV) is a virus that causes several diseases by attacking the human immune system. It is transmitted by contact with certain bodily fluids of an infected person, most commonly during unprotected sex, through sharing needles, or from mother to baby during pregnancy, birth or breastfeeding. The central nervous system is not spared from this virus, as HIV has been shown to induce several neurological disorders. However most neurological pathologies (such as dementia, infections, meningitis, and neuropathy) rarely show until late stages, in this case, after the patients develop acquired immunodeficiency syndrome (AIDS). This article aims to review the neurological disorders in the HIV population and the attempts initiated to limit the disease. METHODOLOGY: Data were collected from medical journals published on PubMed, Ovid MEDLINE, Science Direct and Embase bibliographical databases with a predefined search strategy. All articles considering neurological disorders associated with HIV were considered. RESULTS: To date, the pathogenesis of HIV‐associated neurological complications remains poorly elucidated; thus, imposing a hindrance and limitations on the treatment options. Nevertheless, some studies have reported alterations in dendritic spine as the causative agent for developing brain damage. CONCLUSION: HIV remains one of the most serious global health challenges, with neurological manifestations imposing a major concern among patients with HIV. Despite the availability and efficacy of antiretroviral therapies, yet, the risk of developing neurological complications remains relatively high among patients with HIV. Thus, the 2030 HIV vision must focus on further preventive measures to protect HIV patients from developing such neurological complications

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Insecticidal potential of Ag-loaded 4A-zeolite and its formulations with Rosmarinus officinalis essential oil against rice weevil (Sitophilus oryzae) and lesser grain borer (Rhyzopertha dominica)

The insecticidal efficiency of Ag-loaded 4A-zeolite (ZAg) and its formulations with Rosmarinus officinalis essential oil (RO) was evaluated against Sitophilus oryzae (L.) and Rhyzopertha dominica (F.). For comparison, different rates of ZAg (0.25, 0.5, 0.75, and 1 g kg–1 wheat) were used solely and in a combination with LC50 concentrations of RO. Mortality was assessed after 7, 14, and 21 days of insect exposure to treated wheat. The progeny production was also evaluated. The use of ZAg accomplished a complete mortality (100%) on S. oryzae and 96.67% on R. dominica as well as 100% mortality of progeny against the two insect species after the longest exposing duration (21 days), at the highest rate (1 g ⋅ kg–1). On the other hand, the complete mortalities of ZAg formulations on S. oryzae were obtained after 14 d of treatment with F1 formulation (0.605 g ⋅ kg–1 RO + 0.25 g ⋅ kg–1 ZAg) and after 7 days with the other tested formulations. In addition, the complete mortality on R. dominica was obtained only by F8 (0.059 g kg–1 RO + 1 g kg–1 ZAg) formulation after 14 days of treatment. Concerning the efficiency of the examined formulations on the progeny of S. oryzae, F1 (0.605 g ⋅ kg–1 RO + 0.25 g ⋅ kg–1 ZAg) and F2 (0.605 g ⋅ kg–1 RO + 0.5 g ⋅ kg–1 ZAg) formulations recorded 100% mortality. In addition, F3 (0.605 g ⋅ kg–1 RO + 0.75 g ⋅ kg–1 ZAg) and F4 (0.605 g ⋅ kg–1 RO + 1 g ⋅ kg–1 ZAg) formulations suppressed the progeny production. Furthermore, the complete mortality of R. dominica progeny was obtained with F7 (0.059 g ⋅ kg–1 RO + 0.75 g ⋅ kg–1 ZAg) and F8 (0.059 g ⋅ kg–1 RO + 1 g ⋅ kg–1 ZAg) formulations. ZAg, especially its formulations with R. officinalis oil, had potential effects against two stored-product insects. F1 and F8 formulations could be treated efficiently on S. oryzae and R. dominica, respectively

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie