HER2/neu expression status of post BCG recurrent non-muscle-invasive bladder urothelial carcinomas in relation to their primary ones

Background: Transurethral resection (TUR) followed by adjuvant therapy is still the treatment of choice of Non-Muscle-Invasive Bladder Urothelial Carcinoma (NMIBUC). However, recurrence is one of the most troublesome features of these lesions. Early second resection and adjuvant BCG therapy has been shown to improve the outcome. Objective: To evaluate the prognostic value of C-erbB-2 (HER2/neu) expression status in Non-Muscle-Invasive Bladder Urothelial Carcinoma cases, before and after intravesical Bacillus Calmette Guerin (BCG immunotherapy). Materials and methods: HER2/neu expression was studied in 120 (Ta-T1) Non-Muscle-Invasive Urothelial Carcinoma cases. The expression was evaluated and compared to the expression after Bacillus Calmette Guerin (BCG) immunotherapy. Results: HER2/neu expression in low and high grade of the Non- Muscle-Invasive Urothelial Carcinoma was (38%) and (83%) respectively. The difference of the expression rates by tumor grade was statistically significant. In recurring lesions post BCG therapy, C-erbB-2 expression was markedly decreased (31.6%) when compared to its expression before therapy (65%). Conclusions: The HER2/neu expression increased as the tumor grade rose. The reduction in expression following BCG treatment in Non-Invasive transitional cell carcinoma cases could reflect a reduction of the potential malignancy of the tumor

Occult hepatitis B infection in egyptian chronic hepatitis C patients: prevalence, impact on pegylated interferon/ribavirin therapy

Abstract Background Chronic HCV infection combined with occult hepatitis B infection has been associated with liver enzymes flare, advanced hepatic fibrosis and cirrhosis, poor response to standard interferon-α, and increased risk of HCC. This study aimed to elucidate the prevalence of occult hepatitis B infection in Egyptian chronic HCV patients, and to clarify its role in non-response of those patients to pegylated interferon/ribavirin therapy. This study enrolled 155 consecutive chronic HCV patients under pegylated interferon/ribavirin therapy. All patients were exposed to clinical assessment, biochemical, histological and virological examinations. HBV parameters (HBV DNA, anti-HBc, anti-HBs) and patients' response status to the combination therapy were determined. Results In this study, occult hepatitis B infection occurs in 3.9% of Egyptian chronic HCV patients; tends to affect younger age patients, associated with higher base line HCV viral load, less hepatic fibrosis than monoinfected patients. This occult hepatitis B infection is not a statistically significant cause of non-response to pegylated interferon/ribavirin therapy. Anti-HBs was not associated with any biochemical, histological or virological abnormalities in those patients, contrary to low response rate to therapy and higher HCV viral load that was observed with anti-HBc. Conclusions Detection of HBV DNA in HBsAg negative chronic HCV patients plays a non significant role in non-response of Egyptian patients to pegylated interferon/ribavirin therapy.</p

Unplanned versus planned extubation in respiratory intensive care unit, predictors of outcome

Introduction: The incidence of post-intensive care unit admission complications is high; some of these complications are inevitable and often leads to medical emergencies. Among these complications is the extubation failure whether resulted from planned extubation which is prepared and performed by the medical team or unplanned extubation (UE). Unplanned extubation (UE) is a real event in all ICUS worldwide and is considered as one of the major complications in mechanically ventilated patients. However, its impact on mortality, duration of mechanical ventilation (MV) as well as predictors of UE and need for reintubation had not been adequately defined. Objective: To define the profile of the patients at risk of unplanned extubation and establish predictive criteria for extubation outcome. Patients and methods: This study was carried out in the Respiratory Intensive Care Unit of Chest Department, Zagazig University Hospitals during the period from March 2010 to January 2011. Sixty-seven invasively mechanically ventilated patients who were admitted to the RICU were enrolled in the study. They were (47) males and (20) females with mean age (51.56 ± 6.28) years. Patients were admitted to the RICU because of one of the following diagnostic categories; acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (41 patients), Pneumonia (6 patients), Bronchial asthma (2 patients), Pulmonary edema (5 patients), Bronchiectasis (6 patients), Systemic lupus erythematosus (1patient), interstitial lung disease (ILD) (1 patient), Infected cystic lung (1 patient), Overlap syndrome (4 patients). Patients were classified into two groups according to the way of extubation: Group I: Unplanned extubation group (they were 27 patients who underwent UE either self inflicted (13 patients) or accidental extubation (14 patients) and Group II: Planned extubation group (they were 40 patients who fulfilled weaning criteria and tolerated 2-h spontaneous breathing trial through T-tube without signs of distress and followed by extubation after 24 h). On admission to ICU the following were carried out and recorded for all patients: Full medical history from the patient (if possible) or his relatives, history of previous intubation and/or ventilatory support and Presence of co morbidities, Full clinical examination, Plain chest and heart X-ray, Arterial blood gases, Routine laboratory investigations, Mechanical ventilation, Assessment of APACHE III score (acute physiology and chronic health evaluation score), Assessment of Glasgow Coma Score (GCS) and Assessment of sequential Organ failure score (SOFA). During ICU stay, assessment of the following parameters was done daily including: GCS, Evidence of agitation, Use of sedatives, Degree of sedation using Ramsay Sedation Scoring System, Presence of any physical restrains (Wrist restraints), Amount of endotracheal secretion, Assessment of the strength of the cough reflex by cough strength scale, Nine equivalents of nursing manpower use score (NEMS) to assess nursing workload and Arterial blood gases. If unplanned extubation occurred during anytime before weaning, the following were reported: Time of UE, Ventilation parameters at the time of UE (ventilatory mode, FIO2tidal volume, rate, amount of pressure support and PEEP), Presence of agitation, use of physical restraints, Use of sedation, Last Ramsay score, Last cough strength scale, Last endotracheal secretion scale, GCS at time of extubation, SOFA score at time of extubation, Last NEMS score, Last ABG. If patient passed to weaning and tolerated SBT for 2 h the following tests were performed before extubation in addition to assessment of the same parameters reported among patients in the UE group including Assessment of swallowing by swallowing score, Minute ventilation recovery time, Dead space addition test (DSA), Cuff leak test. The Outcome of the studied patients as regards extubation was categorized into either extubation success or failure. Also the Outcome of the studied cases as regards mortality was classified into either survival or death. Results: The results of this study revealed that the frequency of planned extubation represents 59.7% while unplanned extubation represents 40.3% of the studied subjects. There is no significant difference between planned and unplanned extubation as regards the cause of admission to ICU, (P > 0.05) with predominance of COPD exacerbation which represents 61.19% of the studied population. On starting MV there is an increased risk of unplanned extubation in a significant way with the presence of agitation (74.07%) and decreased the percentage of use of sedation (37.04%), use of physical restraints (77.78%) and lower Ramsay score value (1.33 ± .48), (P value  0.05). Successful extubation is significantly higher in the planned extubation group (75%) in comparison to the unplanned extubation group (18.52%) while extubation failure is significantly higher among the unplanned extubation group (81.48%) in comparison to (25%) in the planned extubation group, (P value  0 .05). The frequency of both ways of unplanned extubation in the studied subjects revealed that self inflicted extubation represents 48.15% while accidental extubation represents 51.85%. There is a significant increase in the duration of MV in self inflicted than in accidental extubation (6.07 ± 2.76 VS 3.35 ± 1.13 days), (P value  0.05). Most of successful extubations among the planned extubation group have a mild amount of E/T secretions (86.67%) and without use of sedation (100%) with a significant difference where extubation failure is significantly higher in moderate and large amounts of E/T secretions, (60%), (P value  0.05). Increased minute ventilation recovery time (12.6 ± 4.7) minutes, and a lower value of swallowing score (13.8 ± 2.62) carry the risk of failed extubation in a significant way, (P value <0.05). Conclusions: An increase in severity of illness on ICU admission, agitation, less use of sedation with lower Ramsay score during MV intensify the risk of unplanned extubation, which usually occurs during the night shift, even with the use of physical restraints. Unplanned extubation is associated with an increased incidence of failed extubation (especially with accidental extubation) and mortality. Factors affecting airway competence; magnitude of cough on command and abundant amount of E/T secretions are significant predictors of extubation failure in planned and unplanned extubation. Prolonged minute ventilation recovery time, failed DSA test and lower swallowing score are associated with an increased risk of failed planned extubation

Percutaneous nephrolithotomy in horseshoe Kidneys: is rigid nephroscopy sufficient tool for complete clearance? a case series study

Abstract Background this study represents a case series to evaluate how successful is the rigid percutaneous nephroscopy as a tool for clearance of all stones in various locations in horseshoe kidneys. Methods Between 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy) for calculi in horseshoe kidneys in 21 renal units (17 patients) in our department. The indications were large stone burden in 18 units and failed SWL(shock wave lithotripsy) in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location. Results The procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal) were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy) drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7% at discharge. Conclusion Percutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.</p

Influence of polymorphisms in candidate genes on carcass and meat quality traits in rabbits.

Candidate gene is a powerful approach to study gene-trait association and offers valuable information for genetic improvement using marker-assisted selection. The current work aimed to study the polymorphisms of four single nucleotide polymorphism (SNPs) at located growth hormone (GH), insulin-like growth factor-II (IGF-II), fat mass and obesity-associated (FTO), and insulin receptor substrate-1 (IRS-1) genes, and their association with the carcass, and meat quality traits in rabbits. The SNPs were genotyped using RFLP-PCR in New Zealand White and local Baladi rabbits. The results revealed that the heterozygous genotype was the most frequent in all cases, except for the FTO SNP in LB rabbits. There was a significant effect for GH genotypes on meat lightness after slaughter and hind-part weight. While, IGF-II mutation significantly affected slaughter, hot carcass, commercial carcass, and hind-part weights. The FTO SNP was associated with cooking loss and intramuscular fat weight, and the IRS-1 SNP was significantly associated with drip loss and intramuscular fat. Specific-breed effects were obtained for IGF-II SNP on cooking loss, and for the intramuscular fat. Although the results suggested that these mutations are useful candidate genes for selection, more research for detecting more variants associated with carcass and meat quality traits in rabbits are recommended

Gastric carcinoma at Tanta Cancer Center: A comparative retrospective clinico-pathological study of the elderly versus the non-elderly

Background and aims: To study the clinico-pathological features, treatments and outcomes of gastric carcinoma (GC) in the elderly (⩾65 years) and the non-elderly Egyptian patients. Methods: This retrospective cohort study included 168 patients with histologically confirmed GC treated at Tanta Cancer Center between 2003 and 2007. Results: Compared to the non-elderly, elderly patients had significantly higher proportion of tumors involving the cardia (p = 0.034) and of adenocarcinoma NOS histology (p = 0.032). Treatments were largely comparable in the two groups. Response to palliative chemotherapy was achieved in 44.4% of the elderly and 25.5% of the non-elderly patients (p = 0.417). The median overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were 6, 17 and 3 months, respectively. The median OS was 4 months in the elderly compared to 9 months in the non-elderly (p = 0.005). The median DFS was 4 months in the elderly compared to 20 months in the non-elderly (p = 0.004). The median PFS was 2 months in the elderly compared to 3 months in the non-elderly (p = 0.685). In multivariate analysis, poor performance status was an independent predictor of poor OS, DFS and PFS. Non-curative or no surgery and lack of chemotherapy use were independent predictors of poor OS. Age was an independent predictor of poor DFS. Conclusions: Compared to the non-elderly, GC in the elderly has similar clinico-pathological characteristics and exhibits comparable outcomes with the same treatment options. Treatments should be tailored to each patient

Hepatocellular carcinoma patients serum modulates the regenerative capacities of adipose mesenchymal stromal cells

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers causing the highest mortality rate worldwide. Treatment options of surgery, radiation, cytotoxic drugs and liver transplantation suffer significant side effects and a high frequency of relapse. Stem cell therapy has been proposed as a new effective therapy, however, controversial reports are emerging on the role of mesenchymal stem cells in cancer.In this work, we aimed to assess the regenerative capacities of adipose mesenchymal stem cells when exposed to serum from HCC patients, by assessing the effect of the sera on modulating the regenerative capacities of h-AMSCs and the cancer properties in HCC cells. This will pave the way for maximizing the efficacy of MSCs in cancer therapy.Our data show that HCC serum-treated hA-MSCs suffered oncogene-induced senescence as shown by their altered morphology and ameliorated proliferation and differentiation. The cells were enlarged with small irregular nuclei, swollen rough endoplasmic reticulum cisternae, and aging lysosomes typified by dark residual bodies. HCC serum-treated Huh-7 cancer cells on the other hand displayed higher tumor aggressiveness as depicted by altered morphology, increased cellular proliferation and migration, and decreased percentage of early and late apoptotic cells.Our findings provide evidence that exposure of hA-MSCs to the serum of HCC patients decreases their regenerative capacities and should be considered when employed as a potential therapy in HCC patients