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Background: Some men are subjected to multiple repeated biopsies because of ongoing suspicion of prostate cancer, which might subject them to complications. The aim of the study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI)/target fusion–guided biopsy in comparison with systematic biopsy in our low prevalence prostate cancer population, in terms of validity measure, case detection rate, and detection of clinically significant cancer. Methods: This is a retrospective cohort study. All consecutive patients who met the inclusion criteria (all men with persistent high prostate-specific antigen levels >4 ng/ml and/or subnormal finding in direct rectal examination, with suspicious regions identified on prebiopsy MRI) were subjected to transrectal MRI/ultrasound fusion–guided biopsy. Results: A total of 165 cases met the inclusion criteria and were included in the study. The cancer detection rate (CDR) of target biopsy was significantly higher than that of standard biopsy (27.9% vs 14%, respectively), and 25 cases (52%) were missed by standard strategy and correctly classified by multiparametric MRI with targeted biopsy (MRI-TB). On the other hand, only 2 cases (4.3%) were misclassified by MRI-TB, and one of them was clinically significant. There was an exact agreement between the 2 strategies in 15 (31%) cases. Targeted biopsy diagnosed 41.5% more high-risk cancers vs systematic biopsy (41.6% vs 6.2%, P

A career in surgery brings significant challenges that can lead to substantial personal distress. To document the prevalence and sources of stress among surgeons working in Saudi Arabia. The survey was conducted between February and June 2019. All participants were surveyed using a self-administered questionnaire interview; it included socio-economic data, data related to work, and an International Stress Management Association stress questionnaire. A total of 357 surgeons were surveyed. Their ages ranged from 21 to 66 years old. Respondents, who expressed themselves as more likely to experience stress and more prone to stress and stress-related illness, were 156 (43.7%) and 150 (42%), respectively. The surgeons, who expressed the most stress, were neurosurgeons (73.1%), followed by urology surgeons (66.7%). Ophthalmologists experienced the least stress at 18.1% while ENT surgeons experienced the second-lowest amount of stress at 25.6%. Age, years of experience, and number of calls per month were identified as significant predictors of stress among surgeons. This study highlights high levels of occupational stress among surgeons. Self-awareness among physicians can enhance the ability to recognize their vulnerability to stress. The results of the study support the potential of mindfulness training to promote resilience during residency.

Background: Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors. Objectives: To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening prac- tices among Saudi men. Methods: This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed. Results: In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate exam- ination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing. Conclusion: Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process. Keywords: Decision making; prostate cancer screening; low prevalence countries.

Thalassemia (Thal) is an inherited blood disorder endemic to the Mediterranean and Middle East (e.g., KSA and UAE). This disease is caused by defects in the synthesis of one or more hemoglobin chains in red blood cells (RBCs). Alpha (α) Thal is caused by a reduced or absent alpha globin segment. Similarly, beta (β) Thal is caused by a defect in the beta globin segment. We divided the diseases into four groups: α Thal trait, α Thal disease, β Thal trait, and β Thal disease. The α or β Thal traits are milder variants of these diseases and do not require treatment; but β Thal disease (and to a lesser extent, α Thal) causes hemolytic anemia, splenomegaly, and bone deformities and requires repeated lifelong blood transfusions. This paper presents results regarding the identification of Thal variants using fluorescence spectroscopy of blood biomolecules and atomic force microscopy analysis of the morphologic features of red blood cells. The combined results provide new insights into the characteristics of these diseases. Furthermore, this study shows why β Thal disease subjects are often transfusion-dependent, and α Thal disease subjects are only occasionally transfusion dependent.

Objectives: To compare transperineal biopsies (TPBx) with transrectal ultrasound-guided biopsy (TRUSBx) in order to provide evidence, making clinicians able to select the appropriate biopsy approach under different conditions. Methods: A comparative prospective study, conducted in King Khalid University Hospital (KKUH) and King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Kingdom of Saudi Arabia, between March 2019 and February 2020. All patients with raised prostate-specific antigen or atypical digital rectal examination findings were subjected to multi-parametric magnetic resonance imaging (MRI). Those with positive findings were referred to targeted fusion- guided biopsy either TPBx or TRUSBx, randomly. Complication rate, cancer detection rate, and procedure time were recorded. Results: Transperineal biopsies and TRUSBx had an equivalent complication rate. However, both case detection rate and clinically significant cancer detection rate were significantly higher in TPBx versus TRUSBx (45.1% versus 29.1%, p=0.003; and 71.8% versus 43.7%, p=0.002; respectively). Transperineal biopsies was a longer procedure than TRUSBx (41.2±0.7 min versus 13±2.3 min, p=0.0001). Conclusion: No difference in complication rate was detected between the 2 procedures; however, TPBx was more effective for cancer detection in general and clinically significant cancer detection in particular.

Objective: This study was aimed to compare the results of immunophenotyping by flow cytometry (FC) and immunohistochemistry (IHC) in the diagnosis of B-cell lymphomas and classic Hodgkin's lymphoma (cHL). Methods: This was a retrospective cohort study of 280 patients with chronic B-cell neoplasms and cHL performed between 2008 and 2013. Percentages of B- and T-cell markers detected by FC and IHC were compared regardless of the final diagnosis. Results: FC and IHC results were obtained from 280 patient medical records. There were 155 (55.4%) patients with non-Hodgkin's lymphoma (NHL), 110 (39.3%) with cHL, and 15 (5.4%) with chronic lymphocytic leukemia (CLL). Disparity between FC and IHC was observed for CD19 expression in cHL group where 73.6% (n = 81) CD19 expression was detected by FC and 59.1% (n = 65) detected by IHC (P < 0.02). In NHL group, a higher percentage (81.3%; n = 126) of CD19 was detected by FC as opposed to 61.3% (n = 95) detected by IHC (P < 0.0001). CD19 expression was no different between the two groups. CD20 expression assessed by FC (61.3%; n = 95) was lower than 85.2% (n = 132) detected by IHC in NHL group (P < 0.0001). Whereas no differences were observed in cHL, IHC performed better (100%; n = 15) than FC (66.7%; n = 10) for CD20 detection in CLL group (P < 0.01). In cHL and NHL groups, flow cytometric detections of CD21 of 61.8% and 56.1% were higher than 46.4% (P < 0.02) and 41.9% (P < 0.01) detection rates by IHC. No disparities were observed between FC and IHC detection rates for CD5, CD10, CD23, and CD30 expressions. Conclusion: There was a considerable amount of disparity between FC and IHC results, warranting further evaluation.

Objective: To describe the reference ranges of serum prostate-specific antigen (PSA) in Saudi men. Materials/Subjects and Methods: Saudi males, aged 30 and above, were invited to participate in the study. Blood samples were taken from each subject to determine serum levels of PSA. Blood sugar levels, lipid profile, and anthropometric measurements were also obtained. Results: Our cohort consisted of 7,814 men; their mean PSA level was 1.24 ng/mL. The majority (90.5%) had PSA values between 0 and 2.5 ng/mL. The median PSA and the 95th percentile increased steadily with age. There was a sharp increase in the 95th percentile, from 3.8 ng/mL in men between 60 and 70 years old to 6.9 ng/mL in men over 71 years old. The 95th percentiles of PSA serum levels were lower in Saudi men than in the general population. Conclusions: PSA serum levels in Saudi men are lower than in other communities. Creating age-specific reference ranges could improve the sensitivity of the PSA tests by allowing the detection of treatable tumors in younger men if the threshold of 4.0 ng/mL is lowered. Furthermore, unnecessary biopsies among older men may be avoided if the threshold is increased.

Objectives : To embrace a national screening program for prostate cancer, putting into consideration the cost, and the attitude of the general population towards such screening. Methods : Men aged greater than 45 and less than 70 years were invited to participate in the current prospective study conducted at King Saud University Medical City, Riyadh, Saudi Arabia between December 2014 and July 2015. Those with confirmed high prostate-specific antigen (PSA) (≥4 ng/ml) were referred to the urology clinic, then subjected to magnetic resonance imaging. Results : The total cohort screened were 2898, we found 118 cases with high PSA (≥4 ng/ml). Fifty-two cases (60.4%) were confirmed high PSA. All of them were subjected to MRI and biopsy. The confirmed prostate cancer were 7 cases (0.24%). The age of confirmed prostate cancer cases ranged from 49 years to 68 years, Gleason score for 4 cases was low grade (3+3), while it was 3+4 for 2 cases, and only one case had advanced cancer (3+5). Approximately 12% of cases with high PSA did not show up for confirmation of their results for further examination. Conclusions : The present study recommends against mass screening among Saudi population; however, men before 50 years of age should start PSA blood testing until before 70 years after discussing the benefits and harms of such screening through shared decision making. Saudi Med J 2017; Vol. 38 (7): 733-737 doi: 10.15537/smj.2017.7.18643 How to cite this article: Arafa MA, Farhat KH, Al-Atawi MA, Rabah DM. Prostate cancer screening in a low prevalence population. Is it worth it? Saudi Med J . 2017 Jul;38(7):733-737. doi: 10.15537/smj.2017.7.18643.

Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cell, showing a rapid growth of lymphoblastic immature cells. Acute myeloid leukemia (AML) is a cancer of the myeloid line of blood cells. Early diagnosis is crucial for the effective treatment of these patients. The current standard procedure of diagnosis is extensive blood count analysis, microscopic morphological investigations, bone marrow biopsy and flow-cytometer which are all time- consuming and expensive. Here we demonstrate the advantage a new technique for the diagnosis of ALL and AML based on the fluorescence spectra of blood plasma and RBCs samples from the above patients. Based on the 85 patients analyzed the results reveal that our approach could discriminate the two malignancies unambiguously from the normal with 88 % sensitivity and 80 % specificity. The abnormal decrease in the level of amino acid, tryptophan and coenzyme NADH and abnormal increase in the other amino acid, tyrosine and another coenzyme FAD, (both in comparison to the normal control) act as malignancy indicative biomarkers. Since the contrast parameter between the normal and malignant samples is four- fold, the potential for early detection of leukemia is high. The instrumentation and technique are new and simple; hence may have significant supplementary or complementary value with the existing diagnostic methods.

This study was designed to find out the optimized energy delivery strategy in Shock Wave Lithotripsy (SWL) that yield to the best stone-free rate (SFR). In this clinical trial, 150 consecutive patients were randomized into three groups: (a) Dose escalation, 1500 SW at 18 kV, followed by 1500 SW at 20 kV then 1500 SW at 22 kV. (b) Constant dose, 4500 SW at 20 kV. All patients undergo plain X-ray film of the urinary tract at day 1, 14, and 90 to assess stone-free rate (SFR) which was defined as no stones or painless fragments less than 4 mm. (c) Dose reduction, 1500 SW at 22 kV, followed by 1500 SW at 20 kV and then 1500 SW at 18 kV. The three treatment groups were comparable in terms of age, sex, stone size and distribution of the kidneys, and the need for Double J stent use. On day 90, the SFR achieved was 82, 90, and 84 % in the escalating, constant, and reduction energy groups, respectively. However, this rate was not statistically significant (x 2 = 1.38, p level = 0.28). At a slow rate of 60 shocks, there was no difference in stone-free rate between different voltages at 1, 14, and 90 days. Our randomized clinical trial showed no statistically significant difference in SFR between the three groups while using the slow SWL rate. Our trial is the first randomized trial comparing the three strategies. As such, a dose adjustment strategy while delivering SWL in slow rate was not recommended.

In order to ensure safe and effective long-term geologic storage of carbon dioxide (CO 2 ), existing regulations require both assessing leakage risks and responding to leakage incidents through corrective measures. However, until now, these two pieces of risk management have been usually addressed separately. This study proposes a methodological framework that bridges risk assessment to corrective measures through clear and collaborative contingency planning. We achieve this goal in three consecutive steps. First, a probabilistic risk assessment (PRA) approach is adopted to characterize potential leakage features, events and processes (FEP) in a Bayesian events tree (BET), resulting in a risk assessment matrix (RAM). The RAM depicts a mutually exclusive and collectively exhaustive set of leakage scenarios with quantified likelihood, impact, and tolerance levels. Second, the risk assessment matrix is translated to a contingency planning matrix (CPM) that incorporates a tiered-contingency system for risk-preparedness and incident-response. The leakage likelihood and impact dimensions of RAM are translated to resource proximity and variety dimensions in CPM, respectively. To ensure both rapid and thorough contingency planning, more likely or frequent risks require more proximate resources while more impactful risks require more various resources. In addition, the minimum and maximum risk tolerance levels are translated to contingency thresholds, and all tolerable risk scenarios are categorized under three contingency tiers: Tier 1, Tier 2, and Tier 3. We highlight how the upper, lower, and inter-tier contingency boundaries should be collaboratively pre-negotiated between the operating party and multiple relevant stakeholders to ensure effective preparedness and response. Finally, we present a model contingency plan to demonstrate how all newly introduced concepts integrate together. Specifically, we focus on explaining how the designed contingency tiers facilitate important aspects of contingency planning, primarily: evaluating leakage and initiating response; designing a corrective measures matrix (CMM) that assigns specific control and remediation measures to each leakage scenario; mobilizing, deploying, and sustaining necessary human and equipment resources; and formulating a decision-making hierarchy, a notification protocol, and a communication scheme to effectively administer the CO 2 storage site.

Polygeneration energy systems (PES) have the potential to provide a flexible, high-efficiency, and low-emissions alternative for power generation and chemical synthesis from fossil fuels. This study aims to assess the economic value of fossil-fuel PES which rely on hydrogen as an intermediate product. Our analysis focuses on a representative PES configuration that uses coal as the primary energy input and produces electricity and fertilizer as end-products. We derive a series of propositions that assess the cost competitiveness of the modeled PES under both static and flexible operation modes. The result is a set of metrics that quantify the levelized cost of hydrogen, the unit profit-margin of PES, and the real-option values of ‘diversification’ and ‘flexibility’ embedded in PES. These metrics are subsequently applied to assess the economics of Hydrogen Energy California (HECA), a PES currently under development in California. Under our technical and economic assumptions, HECA’s levelized cost of hydrogen is estimated at 1.373 $/kg h . The profitability of HECA as a static PES increases in the share of hydrogen converted to fertilizer rather than electricity. However, when configured as a flexible PES, HECA almost breaks even on a pre-tax basis. Diversification and flexibility are valuable for HECA when polygeneration is compared to static monogeneration of electricity, but these two real options have no value when comparing polygeneration to static monogeneration of fertilizers.

Diabetes mellitus (DM) is a common metabolic disease indicated by high sugar levels in the blood over a prolonged period. When left untreated, it can lead to long-term complications, such as cardiovascular disease, stroke, and diabetic retinopathy or foot ulcers. Approximately 415 million people (about 8.3% of the world&rsquo, s population) had diabetes worldwide in 2015, with 90% of the cases classified as Type 2 DM, which is caused by insulin resistance that arises mostly from being overweight and from a lack of exercise. DM affects every part of the body, including the erythrocytes. The aim of the present report is to gain insight into the damage done to the erythrocytes of patients classified with pre-diabetes and diabetes (plenty are found in the Kingdom of Saudi Arabia, a country where young people encompass a large segment of the population). The study presents results on the morphological analysis of erythrocytes by atomic force microscopy (AFM) and molecular investigations by fluorescence spectroscopy (FS). Our results indicate significant differences (in the morphology, size, and hemolytic end products) between the erythrocytes of diabetic patients (HbA1C, glycated hemoglobin, levels of 8&ndash, 10%) and normal controls. It is well-known that DM and smoking are two major contributory factors for cardiovascular diseases (CVDs), and our observations presented in this study suggest that diabetes plays a relatively less damaging role than smoking for CVD.

Sickle cell anemia (SCA) is an inherited blood disorder with worldwide incidence of 15%; out of this, it is found in up to 20% in countries like Kingdom of Saudi Arabia and Bahrain. The standard conventional method of detection is complete blood count (CBC) followed by hemoglobin electrophoresis or high-performance liquid chromatography (HPLC) or both. In this context, spectral detection of variants of sickle cell anemia (SCA) is an innovative technique, which when made accurate and reliable could be an effective alternative, since the instrumentation is compact (5 kg) and hence portable. This makes mass screening even in remote villages possible. In this paper, we give the essential aspects of fluorescent spectral features of sickle cell trait (SCT), sickle cell disease (SCD), beta (β) thalassemia trait (BTT) + SCD, and beta (β) thalassemia disease (BTD) + SCD. All the above four major variants could be discriminated among themselves and also from the normal control blood sample. All these analyses could be carried out with 5 ml of blood, in a time period of 10 minutes. The results of this paper give strong support for an alternative method, a spectral technique, for molecular-level diagnosis of sickle cell anemia and other closely related blood disorders.

Aims: The aim of the following study is to assess the knowledge and attitude of men, in our region, regarding cancer prostate and its screening practices. Subjects and Methods: The field work was conducted in Riyadh City, during the period February through July 2011. It was a population - based cross-sectional study comprising 400 men over 40 years. In addition to socio-demographic data, history of the present and past medical illness, history of prostatic diseases and examination, family history of cancer prostate; participants were inquired about their knowledge and attitude toward prostate cancer (PC) and screening behavior using through two different Likert scales. Results: Only 10% of the respondents had practiced a regular PC examination checkup. Their knowledge about PC was poor and their attitude toward examination and screening was fair, where the mean of total correct knowledge score was 10.25 ± 2.5 (51.25%), while the mean of total attitude score was 18.3 ± 4.08 (65.3%). The respondents identified the physicians as the main sources of this information (62.4%), though they were not the main motives for a regular checkup. Knowledge represented the only significant predictor for participants' attitude. Conclusion: Beliefs and attitudes have a great impact, at every stage of the cancer continuum, this attitudes depends mainly on level of knowledge and quantity of information provided to patients and their families. Such attitudes should rely on a solid background of proper information and motivation from physicians to enhance and empower attitudes toward PC screening behavior.

Background Pain is a common and dose-limiting side effect of many potentially curative cancer chemotherapeutic agents. This chemotherapy-induced pain (CIP) affects the quality of life of cancer patients and survivors and hampers the optimal clinical management of chemotherapy in cancer patients. The underlying mechanisms remain largely unknown, but changes in levels of cytokines/chemokines may contribute to the pathophysiology of CIP. Objective This retrospective study was aimed at examining whether plasma levels of various cytokines change in prostate cancer patients after chemotherapy treatment and whether such changes (if any) are associated with their pain intensity. Methods Using a Luminex assay, plasma levels of 27 cytokines/chemokines were measured in 78 men: 30 patients with metastatic prostate cancer who received chemotherapy (Docetaxel, 75 mg/m2 intravenously), 29 untreated patients with nonmetastatic prostate cancer, and 19 healthy controls. Subjective pain was assessed in chemotherapy-treated cancer patients using the 11-point numeric rating scale (NRS) pain scores. Results Chemotherapy-treated patients with pain (NRS ≥ 3) exhibited significantly increased levels of the pro-inflammatory cytokines (IL-6, IL-8) and chemokines (Eotaxin, VEGF, and IP-10) compared with untreated cancer patients or with patients without pain (NRS = 0). Of the 27 cytokines examined, only IL-6 was positively correlated with pain intensity in the chemotherapy-treated patients with pain. Conclusions These findings suggest that the cytokines, particularly IL-6, whose levels were elevated in the chemotherapy-treated patients may be involved in the pathophysiology of CIP, and that they might be potential new targets for pain control in cancer patients receiving chemotherapy.

The method of detecting bladder cancer by optical analysis of bodily fluids utilizes optical techniques to determine a concentration of porphyrin in a patient's bodily fluid sample. The patient is administered 5-aminolevulinic acid and, approximately eight hours later, a bodily fluid sample is collected from the patient, and this bodily fluid sample is optically analyzed to measure a concentration of porphyrin therein. Optical analysis is preferably performed by laser-induced fluorescence spectroscopy. If the measured concentration of porphyrin is approximately three times a pre-determined porphyrin concentration for a healthy person of the same age as the patient, then the patient is diagnosed with bladder cancer.

Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of death. Reduction in mortality rates in some countries worldwide are most likely ascribed to CRC screening and/or improved treatments. We reviewed the most relevant articles which discuss the cost-effectiveness of colorectal cancer screening procedures, in particular, the recent ones through the last eight years. The effectiveness of screening estimated by discounted life years gained (LYGs) compared to no screening, differed considerably between the studies. Despite these differences, all studies consistently emphasized that screening for CRC was cost-effective compared with no screening for each of the recognized screening strategies. Newer technologies for colorectal cancer screening, including computed tomographic colonography (CTC), faecal DNA test, and Pillcam Colon are less invasive and accurate, however, they are not cost-effective, as their cost was higher than all other established screening strategies. When compliance and adherence to such new techniques are increased more than the established strategies they would be more cost-effective particularly CTC.

Mortality due to breast cancer is on the decline particularly in the western world because of early detection technique such as mammography. In spite of the real success, this has its limitation because women needs to get exposed to ionizing radiation and many women in the eastern world would not like to be subjected to such breast exposure due to cultural inhibitions. In addition, the sensitivity is not more than 75%. In this context, research in optical biopsy is in the forefront since it is minimally invasive and done with non ionizing radiation. The laser beam could be launched through a hair thin fiber and the scattered radiation obtained from the sample could give spatially resolved information about the biochemical nature of the breast cancer sample. What is more important, the optical biopsy could be done based on spectral analysis of blood plasma itself so that in the long run a large segment of prospective women even in the rural areas can be screened just by blood analyses. The objective of our research is to evolve one such protocol and the first step is the spectral characterization of in vitro optical analyses of breast cancer samples. This is only the proof of the concept from a limited number of samples.

Background: Benign prostatic hyperplasia-related lower urinary tract symptoms (LUTS) are common among older men, the incidence and prevalence are increasing rapidly, and they are associated with diminished health-related quality-of-life (QOL). Objective: The aim was to describe the prevalence of LUTS in Saudi population and its relation to some other parameters. Subjects and Methods: Saudi men over the age of 40 were invited to participate in the study; in Riyadh city from August 2012 through March 2013. All participants were assessed for the serum level of prostate-specific antigen (PSA) and digital rectal examination. Participants were given a linguistically validated Arabic version of the International Prostate Symptom Score (IPSS). Demographic and other medical comorbidities were assessed. Results: Based on the IPSS, a subdivision of men into three symptoms classes has been proposed, resulting in groups with mild (1265, 58.3%), moderate (505, 27.3%), and severe symptoms (81, 4.4%) and the prevalence of moderate to severe was 31.7%. There was a weak, but significant correlation between the total IPSS and age, total prostate volume, and PSA. Severity of symptoms is increasing with increased age. Multiple regression analysis reported that prostate volume and all individual items of IPSS except straining were significant predictors of QOL and patient satisfaction, where frequency and incomplete emptying had the heaviest impact on patient's QOL. Conclusion: LUTS were common among men in Saudi population over 40, the prevalence increases with age and most of them were unpleased because of their urinary symptoms, poor QOL was mainly determined by individual symptoms; mainly frequency and incomplete emptying.

Summary Gleason score is the most common method of grading the virulence of prostate malignancy and is based on the pathological assessment of morphology of cellular matrix. Since this involves the excision of the tissue, we are working on a new, minimally invasive, non-contact, procedure of spectral diagnosis of prostate malignancy. In this preliminary in vitro study reported here, we have analyzed 27 tissue samples (normal control = 7: benign = 8: malignant = 12) by Stokes’ shift spectra (SSS) to establish a one-to-one correspondence between spectral grading and Gleason grading.

Gleason score is the most common method of grading the virulence of prostate malignancy and is based on the pathological assessment of morphology of cellular matrix. Si nce this involves the excision of the tissue, we are working on a new, minimally invasive, non contact, procedure of spectral diagnosis of prostate malignancy. In this preliminary in vitro study reported here, we have analyzed 27 tissue sample s (normal control =7: benign=8: malignant =12) by Stokes’ shift spectra (SSS) to establish a one- to- one corre lation between spectral grading and Gleason grading. Key Words: Spectral grading and Gleason grading, maligna nt prostate tissue, Stokes' shift spectra. 1.INTRODUCTION Gleason Score (GS) is the most common method of grading the prostate cancer tissue in order to understand how much and how fast the malignancy is spreading. This kind of scor ing, though subjective and varies considerably between two professional pathologists, has been a useful tool for long term prognosis of the afflicted patients. This score is based on the microscopic appearance of the tissue a nd greater the score the more aggressive the disease and worse the prognosis. The pathologist assign a score 1 for the normal well differen tiated tissue which has small, well formed uniform glands; he assigns a score of 5 for the poorly differentiated, irregular mesh of cells with few glands. Most often the tissues do not have such well defined structure, but exhibit a mix of two patterns: A primary or the most prominent pattern and a secondary, less prominent pattern, say 3 and 4 or 4 and 3. Though for both cases the total score is 7, the former one has better prognosis than the latter. The primary pattern determines the Gleason grade, which runs from 1 to 5; the combination of grades of two important patterns is called Gleason Score.[1] The objective of this paper is to establish a parallelism between the Gleason score of microscopic cellular morphology and the spectral features of fluorescencent bio markers of the malignant prostate tissues. For men above sixty, benign prostate hyperplasia (BPH) is common; and cancer of prostate (CaP) is rare. Optical techniques were recently used in differentiating BPH from Ca P. Raman spectroscopy has been employed to detect and grade prostatic adeno carcinoma [2]. This study showed discrimination between BPH and CaP based on increase in concentration of nucleic acid and decrease in glycogen for CaP, as compared to BPH. This reduced level of glycogen has also been reported with independent FTIR (Fourier transform – infra red) study [3]. Magnetic resonance spectroscopy (MRS) has also been used to delineate citrate levels [4] and the ratio of creatine and myo-inositol [5], as parameters for BPH and CaP discrimination. Recently, research based on native fluorescence and Raman si gnals of malignant tissues, a technique known as optical biopsy, is gaining importance [6-8]. In spite of extensive work done on native fluorescence of malignant tissues of many cancers, significant results of endogenous fluorescence analysis in discrimination of BPH and CaP has been reported only very recently [9] A few biomolecules in the human body have endogenous fluorescence, with unique combination of excitation and emission maxima, which taken together can serve as a fingerprint for the molecule. Native fluorescence analysis of

Background: Prostate cancer is the most common malignancy in many industrialized countries and the second cause of cancer-related death in Europe and the United States. The incidence of the disease has been increasing in Arab populations. Large databases focused on genetic susceptibility to prostate cancer have been accumulated from population studies of different ancestries, including Europeans and African-Americans. Arab populations, however, have been only rarely studied. Genetic susceptibility to prostate cancer differs significantly across ethnicities. It would be of interest to identify the common alleles associated with prostate cancer risk in Arab population. Methods: With Affymetrix Genome-Wide Human SNP Array 6.0, we conducted a genome-wide association study (GWAS) in which 534,781 single nucleotide polymorphisms (SNPs) were genotyped in a Tunisian cohort of 92 cases with prostate cancer and 131 age-matched controls. Then we extended the study to evaluate promising associations of 11 SNPs, identified by GWAS, in a cohort of individuals of Arab ancestry living in Qatar and Saudi Arabia (155 cases and 182 controls) using TaqMan® SNP Genotyping Assays. Results: We identified 3 consecutive regions significantly associated with prostate cancer risk on chromosome 9, 17 and 22, including 18 SNPs (P=8.52×10-5 to P=2.18×10-6) in the Tunisian population. Three previous reported common loci associated with prostate cancer at 17q21 containing STAT3 gene in the Caucasian population were confirmed. Two novel chromosomal regions associated with prostate cancer contain candidate susceptibility genes: SMARCA2, LOC646851and SUN2 were revealed. Conclusion: Our findings, identifying novel GWAS prostate cancer susceptibilty loci, indicate that prostate cancer genetic risk factors could be ethnic specific.

In this study, we present the results of fluorescence spectra of blood and urine to detect and discriminate between samples drawn from benign and malignant prostate patients and we find a very good demarcation in terms of spectral features. This preliminary study was carried out as a proof of concept, with limited samples of blood and urine from known cases of patients of BPH and CaP. In the near future it is expected that a detailed clinical validation will be done to establish it as a reliable cancer diagnosis protocol.

Introduction Prostate cancer is the most common malignancy in many industrialized countries and the second cause of cancer-related death in Europe and the United States. The incidence of the disease has been increasing in Middle Eastern and North African (MENA) populations. Large databases focused on genetic susceptibility to prostate cancer have been accumulated from population studies of different ancestries, including Europeans and African-Americans. MENA populations, however, have been only rarely studied. Genetic susceptibility to prostate cancer differs significantly across ethnicities, e.g., the allele frequencies of the candidate prostate cancer susceptibility genes such as CYP3A4 and SRD5A2 differ substantially by ethnicity. It would be of interest to identify the common alleles associated with prostate cancer risk in MENA population. Material and Methods With Affymetrix SNP 6.0 chip, we conducted a genome-wide association study (GWAS) in which 534,781 single nucleotide polymorphisms (SNPs) were genotyped in a Tunisian cohort of 85 cases with prostate cancer and 131 age-matched controls. Then we extended the study to evaluate promising associations of 11 SNPs, identified by GWAS, in a cohort of individuals of Arab ancestry living in Qatar and Saudi Arabia (155 cases and 182 controls) using TaqMan® SNP Genotyping Assays.Results: We identified 3 consecutive regions significantly associated with prostate cancer risk on chromosome 9, 17 and 22, including 18 SNPs (P = 8.52 × 10 - 5 to P = 2.18 × 10 - 6) in the Tunisian population. 11 out of these 18 SNPs are not associated with prostate cancer risk in the population living in Qatar and Saudi Arabia. Conclusions We confirmed previous reports of common loci associated with prostate cancer at 17q11 and 17q21 containing STAT5A and STAT3 in the Caucasian population. Moreover, we found that 2 new consecutive regions associated with prostate cancer contain candidate susceptibility genes: SMARCA2, GNAQ, SEPT9, MYO18B and SUN2. Additionally, our findings further proved that prostate cancer risky genetic factors are ethnic specific.

This paper investigates the economic attractiveness of exporting coal-generated electricity from the State of Wyoming to the State of California while investing in large-scale CO 2 capture and sequestration to meet California's strict environmental regulations. The project involves partially capturing CO 2 from coal power plants, storing it temporarily underground using CO 2 Interim Storage, and ultimately using it for Enhanced Oil Recovery. A detailed financial assessment is performed in view of current electricity prices and federal and state regulations in the U.S., especially those related to CCS tax credits. The results show that the project is profitable under current regulations and technical assumptions, and it can be a good opportunity to drive large-scale deployment of CCS, along with the development of EOR activities and the deployment of the newly proposed CO 2 Interim Storage technology.

In the absence of legislation that imposes a price on CO 2 emissions, few significant economic incentives currently exist for largescale commercial application of CO 2 Capture and Storage (CCS). A novel technique, currently under development, shows potential to add value to sequestered CO 2 , promote its utilization, and bridge the gap between its supply and demand, thus allowing the development of fully-integrated and reliable CO 2 market. This technique is referred to as “ CO 2 Interim Storage”, or briefly, CIS. CIS involves storing CO 2 for a finite period of time to be subsequently utilized in CO 2 Enhanced Oil Recovery (EOR) and potentially other industrial processes. The feasibility of CO 2 storage is assessed based on three major variables: The distance between CO 2 source and storage medium, the general trend of CO 2 storage in and delivery from the storage medium (primarily governed by the market dynamics of supply and demand), as well as the frequency of CO 2 injection into and extraction from the storage medium. The importance of CIS as a major tool for CO 2 market and infrastructure development becomes clear upon comparing this new technology to the widely implemented underground natural gas (NG) storage and assessing its role in energy hybridization and in meeting variable and localized CO 2 demand. In this study, the flow of CO 2 in underground storage reservoirs is numerically simulated to provide general analysis of the technical aspects associated with varying CO 2 injection rates. The simulations show that the CO 2 plume and pressure buildup profiles are comparable for constant and variable injection rates. Also, in the cases of variable injection, the pressure variation dampens as injection proceeds with time. In addition, a casestudy is conducted in which CIS is implemented to meet the CO 2 demand for EOR operations in the state of Wyoming from CO 2 emissions of in-state coal power plants. This is achieved via modeling an integrated source-sink CO 2 network. The results show that the economic attractiveness of the project is dependent on the availability of CO 2 , the distance between CO 2 sources, interim storage sites, and sinks, as well as the price and demand of CO 2 for EOR.

Colorectal cancer (CRC) incidence and mortality rates have dropped 30% in the US in the last 10 years among adults ages 50 and older due to the widespread uptake of colonoscopy, yet incidences in the Arab countries have been increasing in the past ten years, albeit with lower figures when compared with developed countries. Lifestyle changes, food consumption patterns and obesity have been observed during the past years where the regular consumption of traditional foods is being replaced with more Western-style and ready-made foods. Most high income countries have implemented population based colorectal cancer screening programs, which aid in decreasing the incidence and mortality of cancer, while these are lacking in most of the Arab world countries due to many cultural and religious barriers to CRC screening as well as lack of high education or familiarity. What is needed is health education to modify risky lifestyle, and to increase motives and enhance positive attitudes towards early screening especially amongst high risk groups in addition to policy designed to encourage healthier living.

Background Epidemiological studies have shown that the offspring of mothers who experience diabetes mellitus during pregnancy are seven times more likely to develop health complications than the offspring of mothers who do not suffer from diabetes during pregnancy. The present study was designed to investigate whether supplementation of streptozotocin (STZ)-induced diabetic pregnant mice with thymoquinone (TQ) during pregnancy and lactation improves the risk of developing diabetic complications acquired by their offspring. Methods Three groups of pregnant female mice were used: non-diabetic control dams (CD), diabetic dams (DD), and diabetic dams supplemented with TQ (DD + TQ) during pregnancy and lactation (n = 10 female mice in each group). Results Our data demonstrated a marked decrease in the number of neonates born to DD, and these neonates showed a marked increase in their mean body weight (macrosomic pups) compared to those born to CD and DD + TQ. The induction of diabetes during pregnancy and lactation resulted in macrosomic pups with several postpartum complications, such as a marked increase in their levels of blood glucose, free radicals, plasma pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α), and lipids, and a tendency toward abnormal obesity compared to the offspring of CD. By contrast, macrosomic offspring born to DD exhibited a marked reduction in plasma cytokine levels (IL-2, -4 and -7), an obvious reduction in the number of circulating lymphocytes, decreased proliferation of superantigen (SEB)-stimulated lymphocytes and aberrant AKT phosphorylation. Interestingly, the supplementation of DD with TQ during pregnancy and lactation had an obvious and significant effect on the number and mean body weight of neonates. Furthermore, TQ significantly restored the levels of blood glucose, insulin, free radicals, plasma cytokines, and lipids as well as lymphocyte proliferation in the offspring. Conclusions Our data suggest that the nutritional supplementation of DD with the natural antioxidant TQ during pregnancy and lactation protects their offspring from developing diabetic complications and preserves an efficient lymphocyte immune response later in life.