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Complete metastasectomy is the best predictor of survival in patients with osteosarcoma pulmonary metastases. There has been some controversy in the literature regarding the prognostic significance of the timing of occurrence of lung metastasis.We reviewed the clinical course of all osteosarcoma patients with pulmonary metastases treated by metastasectomy in our hospital from January 2008 through December 2016. Each patient who underwent metastasectomy was placed into one of three groups based on whether lung metastases were present at initial presentation (Group 1), developed during chemotherapy (Group 2), or appeared after completion of chemotherapy (Group 3). Data were obtained retrospectively and follow-up was obtained until the end of June 2017.We identified 170 patients with pulmonary nodules of whom 99 (58.2%) underwent at least one metastasectomy (149 thoracotomies). Eleven patients had benign pulmonary nodules and were excluded. The other 88 patients were classified as Group 1 (37), Group 2 (18) or Group 3 (33). The median follow-up was 35 months (range 8 to 99). Postmetastasis 5-year overall survival (OS) was 38.1 ± 6.4%; event-free survival (EFS) was 25 ± 5.3%. By group, postmetastasis 5-year OS and EFS were 34.3 ± 13% and 18 ± 9.3% in Group 1, 8 ± 6.5% and 6.5 ± 5% in Group 2, and 52 ± 11.4% and 25 ± 9% in Group 3 (P 0.001). In univariate analysis, the only significant factors associated with survival were timing of occurrence of lung metastasis and the number of lung nodules found.The timing of occurrence of lung metastasis is an important prognostic factor among osteosarcoma patients eligible for metastasectomy. Patients whose metastases occurred during chemotherapy had the worst survival.Level II.

AIM The aim of this study was to evaluate the diagnostic and prognostic performance of miRNA-29a and miRNA-100 in pediatric acute myeloid leukemia (AML). PATIENTS AND METHODS In all, 73 children with diagnosed pediatric AML (based on standard morphologic, cytochemical, cytogenetic, immunologic, and molecular workup, and the French-American British classification) admitted to Children's Cancer Hospital Egypt (CCHE-57357), and 9 healthy age-matched and sex-matched controls were recruited for a case-control study. Gene expression levels of miRNA-29a and miRNA-100 were assessed using real-time quantitative RT-PCR. RESULTS When diagnosed, patients had a significantly higher expression of miRNA-100 as against controls (median [range]: 12.99 [0.92-851.38] vs. 0.26 [0.03-2.67], P

Childhood cancer is a priority in Egypt due to large numbers of children with cancer, sub-optimal care and insufficient resources. It is difficult to evaluate progress in survival due to paucity of data in national cancer registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n=15,779, aged 0-18 years) from Egypt between 2007-2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40-50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14,808 eligible patients using Kaplan Meier method, and determined survival trends using Cox regression by single year of diagnosis, and diagnosis periods. We compared age-standardized rates to international benchmarks in England and the US, identified cancers with inferior survival, and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (p

Objectives A high prevalence of rickets of unknown aetiology has been reported in Chakaria, Bangladesh. Classically, rickets is caused by vitamin D deficiency but increasing evidence from Africa and Asia points towards other nutritional deficiencies or excessive exposure to some metals. The aim of this study was to investigate the aetiology of rickets in rural Bangladeshi children. Methods 64 cases with rickets-like deformities were recruited at first presentation together with age-sex-village matched controls. Data and sample acquisition included anthropometry, radiographs, fasted plasma and urinary samples, 24 h weighed dietary intake together with a 24 h urine collection, and 13C-breath tests to detect Helicobacter (H.) pylori infection. Results One child had active rickets and frank hypovitaminosis D (F, n = 1) and one had deformities with radiological features of Blount disease (M, n = 1). The remaining cases were grouped into those with active rickets, defined as a radiographic Thacher score ≥1.5 (Group A, n = 24, 12M, 12F) and rickets-like bone deformities but not active rickets (Group B, n = 38, 28M, 10F). All children had a low dietary calcium intake, but this was lower in Group A than their controls (mean (SD): 156 (80) versus 323 (249) mg/day, p = 0.005). Plasma 25-hydroxyvitamin D (25OHD) was lower in Group A compared to controls; 63% of Group A and 8% of controls had a concentration, Highlights • Rickets in Chakaria, Bangladesh was associated with low dietary calcium intake. • Low vitamin D status (>clinical deficiency range) and exposure to metals were noted. • Chronically low calcium intakes caused urinary phosphate wasting and rickets. • Phosphaturia was not driven by elevated FGF23 rather secondary hyperparathyroidism. • Rickets showed no relationship with H. pylori infection, anaemia or iron deficiency.

The Architectural, engineering, and construction (AEC) industry projects in Syria struggled with myriad problems. However, Building Information Modelling (BIM) technology worldwide proves its capability to solve these issues, Syrian AEC companies are rarely using BIM. Therefore, the aim of this study is to improve the BIM performance in Syrian AEC companies which are already in the BIM zero level and to provide strategies to the companies which do not use BIM for BIM adoption in their projects. An extensive literature review has been conducted to investigate the latest strategies and frameworks to implement and improve BIM performance. In addition to, an online questionnaire analysed by SPSS software and Excel to develop the suggested framework. Furthermore, the General Company for Engineering Studies and Consultations (GCEC) is selected as a case study to validate the framework. This study assessed and enabled the company to improve its BIM performance by using BIM maturity matrix (BIM3) through three stages: 1) Identified BIM and its performance, 2) Performance measurement, 3) Performance improvement. This study provides a new and novel companies’ BIM performance improvement framework which consisted of three fields: policy, process, and technology. The results of this study assisted to identify, obtain, and improve BIM interactions between individuals and companies to enhance the collaboration between all project participants. The future research will attempt to test and validate the proposed framework for private sector companies.

Recently, Building information modelling (BIM) proves its capability to solve the raised AEC industry issues. Therefore, several countries and entities pursue to transform into BIM especially the developed countries. Lithuania as a European country has a great challenge to cap up with the surrounding environment to implement BIM. This study aims to determine the BIM maturity levels in Lithuania and supposed the missed steps to upgrade to the next level. Eighteen important Lithuanian construction projects awarded the most successful implementing BIM are chosen as a case study. Face-to-face interviews were conducted with several BIM experts whose work at the chosen projects. The analysis conducted by the most effective theoretical model entitled BIM Maturity Matrix (BIMM). The key findings of this research that Lithuania reached the BIM implementing maturity level 2 while some projects still at level 1 that proves the ability of Lithuanian AEC industry to softly and completely transfer the maturity to level 2 by the recommendation provided through the proposed approach at the end of the paper. These results provide a stunning opportunity to improve the AEC project performance and reap the benefits of implementing BIM. Future studies can develop a framework to improve the BIM implementation in Lithuania softly.

ObjectiveSuboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged DesignSearches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0–2 years and/or their families. Search terms: ‘children’, ‘feeding’ and ‘Asians’ with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).ResultsFrom 45 712 results, seventeen studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF was found in all studies. Nine of fifteen studies assessing timing recorded CF introduced between 6 and 9 months. Five of nine observed dietary diversity across four of seven food groups; and two of four, minimum meal frequency in over 50 % of participants. Influencing factors included lack of CF knowledge, low maternal education, socio-economic status and cultural beliefs.ConclusionsThis is the first systematic review to evaluate CF practices in Pakistan. Campaigns to change health and nutrition behaviour are needed to meet the substantial unmet needs of these children.

These days Syria is concerned in the development of integrated strategy, starting with a provision of regional, structural and organizational planning for the affected areas, followed by the architectural and construction and environmental studies, etc. This strategy is achieved through the preparation of detailed plans and programs necessary for the implementation of public and private projects that achieve the objective of development and reconstruction. This study includes a range of plans that must overlaps and integrates with each other to produce reconstruction operations. Work team must be involved in the implementation of these plans. The work team composed of officials and experts, technicians and consultants, and bound together through a flexible structure consisted of a group of sub-committees that are related to a higher body for reconstruction. In the stage of the housing plan, researches were done in order to assess the reality of the construction of buildings in Syria, and compared with the concepts and the construction industry characteristics (IBS), and determine the Syrian experiment site regarding to these concepts, as well as evaluating the factors affecting this industry, and proposals to apply it in reconstruction stage. Cast-in-place concrete in the case of the reinforced walls, got 13.1%, while in the case of the framework structure was 34%, and templates tunnelling was 64%, composite order (pre-cast and Cast-in-place concrete) was 61%, composite order (concrete and metallic) was 67.25%, and the pre-cast concrete was from 82% up to 86%. The questionnaire also shows that the trend towards a modern building industry faces significant challenges in spite of its inevitability as a strategic decision in finding solutions to the problems of housing and reconstruction. The research arranged the priority use of technical systems in construction in Syria, using the method of AHP. The advanced technology system (pre-cast concrete) had the first place with 39.4%.

Prefabrication is a manufacturing process conducted at a specialized facility, in which various materials are joined to form a component part of the final installation. Prefabrication techniques have been progressively adopted in the construction industry in various countries. The demand was at its peak in the early 1970s in Eastern and Western Europe for the construction of new towns. Worldwide, the highest precast levels in 1996 were located in Denmark (43%), the Netherlands (40%), Sweden and Germany (31%). In Asia, the precast levels in Japan and Singapore were about 15% and 8%, respectively, recently, the use of prefabrication is further encouraged to increase productivity and build ability. In Syria too, the first residential project in Damascus: the establishment of 2400 housing units in the year (77-80). Except that the rate of construction pre-cast in Syria is still not exceed 2% of Building of reinforced concrete. In order to participate in the reconstruction of Syria, after the destruction and devastation caused by the war over four years, this search evaluates successful international experiences in rapid construction technique, and modeled system that could serve the current Syrian reality. Introduction of this technology as a new method in the world of construction in Syria requires a good base, relying on the availability of the necessary raw materials and nearness of work site, as well as the need to replace old technology into modern technology, and analyzing the economic, social, environmental criteria, to make the decision about the best solution. Cost and time will form the most important indicators that will be analyzed and calculated, before the final model mode, in order to be able to use this system later in Syrian construction companies.

Burkitt lymphoma (BL), a highly aggressive B-cell non-Hodgkin lymphoma (NHL), usually presents in children and young adults with large extranodal masses involving jaw bones, gastrointestinal tract, and central nervous system. The three main subtypes of BL are endemic, sporadic, and immunodeficiency variant. Extranodal involvement is common in each variant of BL, although muscle tissue involvement is distinctly rare. Mode of spread may be hematogenous or via direct extension of the primary tumor. In this report, we present a case of a 41-year-old male who presented with a palpable mass in the buttock leading to foot drop as the initial manifestation of BL. An exhaustive review of the literature failed to discover any previous reports of BL occurring in this location.

Aims Sub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. We aimed to undertake a systematic review of studies assessing CFP in SA children aged 0– 2 years in Bangladesh, India and Pakistan. Methods Searches undertaken between January 1990 to June 2016; MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity and Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CFP in SA children aged 0–2 years and/or their families. Search terms were: ‘children’, ‘feeding’ and ‘Asians’ with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence). Results From 45,712 studies identified, 126 descriptive studies (105 cross-sectional, 11 cohort, 8 qualitative, 1 case-control and 1 mixed studies) were included. 73 from India, 17 Pakistan and 36 Bangladesh. Despite each adopting WHO Infant and Young Children Feeding (IYCF) Guidelines, CFP were sub-optimal in all three countries. In Pakistan, of 15 studies reporting CFP timings, 8 recorded timely initiation (between 6–9 months). Of those reporting dietary diversity, 3 of 9 studies met minimum dietary diversity requirements across 4 of 7 WHO IYCF food groups. 2 of 3 studies observed minimum meal frequency in over 50% of participants. In India 35 of 59 studies reported timely initiation of CFP. 7 of 9 studies noted minimum dietary diversity achieved between 10%–23% of the study population. 5 of 15 studies noted minimum meal frequency achieved between 25%–96% of the study population. In Bangladesh, in 13 of 36 studies timely initiation of CFP ranged from 42%–64%. 3 of 17 studies noted minimum dietary diversity achieved between 19.8%–57.7% of the study population. 1 of 7 studies noted minimum meal frequency achieved between 33%–81% of the study population. Influencing factors included poor education about CFP, cultural beliefs and socioeconomic variables. Conclusion This is the first SR to evaluate CFP in infants in India, Pakistan and Bangladesh. There is a great need for revision of nationwide child health programmes and campaigns to change health and nutrition behaviour.

Background Sub-optimal nutrition among children remains a significant problem in South Asian (SA) families across the world and is related to micronutrient deficiencies, obesity and dental caries. The optimisation of complementary feeding practices (CFP) in the first two years of life is vital in tackling these issues. Aims To undertake a systematic review of studies assessing CFP, timing, dietary diversity, and influencing factors in children under two years of age in SA in developed countries (DC). Methods We searched Medline, Embase, Global Health, Web of Science, OVID Maternity and Infant Care, Cochrane Library, Popline, and WHO Global Health Library from January 1st 1990 to June 30th 2016. Eligibility criteria were all primary research studies on CFP in SA children aged 0–2 years, their families, or both, restricted to the English language. Search terms were ‘children’, ‘feeding’, and ‘Asians’ with their derivatives. Study selection, data extraction, and quality appraisal (EPPI-Centre weight of evidence) were performed by two independent researchers in a narrative synthesis approach. Results From 45 712 studies screened, 860 full-text articles were assessed for eligibility with 135 included in the synthesis. 10 studies from developed countries (UK, USA and Australia) were finally extracted. Despite adopting the WHO Infant and Young Children Feeding (WHO IYCF) guidelines, sub-optimal CFP were found in all studies. In 3 of 4 studies which addressed timing, CF was introduced before 6 months; and was not introduced between 6–12 months in any study despite recommendations. Coverage of The Pregnancy Book and Birth to Five ranged from 94% among Caucasian mothers but fell to 68%–88% among SA mothers. Dietary diversity was inadequate in 6 of 7 studies which discussed it with sweet convenience foods commonly used. Factors affecting practices included: acculturation, socioeconomics and conflicting sources and content of information. Conclusions This is the first systematic review to evaluate complementary feeding practices in SA across DC. In comparing the findings to those from reviews assessing developing countries, similar sub-optimal practices were noted between families from both types of countries despite ratification of WHO IYCF guidelines. This review will contribute towards informing future intervention development.

Breast Cancer is the commonest maligrancy in woment. A study was carried out in the Department of Biochemistry, Dhaka Medical College to investigate some of the biochemical features that are associated with breast cancer occurring in Bangladeshi women. Thirty diagnosed breast cancer patients and thirty healthy women were selected. A questionnaire was used for collecting information regarding age, family history, physical activity and exercise, BMI, diet, smoking, alcohol abuse, addiction, details of menstrual and obstetric history, breast-feeding, parity, use of contraceptives and HRT. Blood samples were collected and tested for fasting lipid profiles, serum estrogen and progesterone. The study has revealed that high levels of serum total cholesterol (P

Background Sub-optimum nutrition among children remains an important problem among South Asian families in the UK. Appropriate complementary feeding practices in the first 2 years of life greatly reduce the risk of obesity and stunting. The UK diaspora is hypothesised to have similar complementary feeding practices to their countries of origin (India, Pakistan, and Bangladesh); if so, this could inform practice in the UK via reverse translation of evidence. We aimed to undertake a systematic review and narrative synthesis of studies assessing complementary feeding practices, and the beliefs that underpin them, in children under 2 years old within South Asian families living in the UK, India, Pakistan, and Bangladesh. Methods We searched Medline, Embase, Global Health, Web of Science, OVID Maternity and Infant Care, Cochrane Library, Popline, and WHO Global Health Library from Jan 1, 1990, to June 30, 2016. The eligibility criteria were all primary research studies on complementary feeding practices in South Asian children aged 0–2 years, their families, or both, restricted to the English language. The search terms used were "children", "feeding", and "Asians" with their derivatives. Study selection, data extraction, and quality appraisal (EPPI-Centre weight of evidence) were performed by two independent researchers in a narrative synthesis approach. This study is registered with PROSPERO, number CRD42014014025. Findings From 45 702 studies identified, 157 descriptive studies (115 cross-sectional, 19 cohort, 14 qualitative, one case-control, and eight mixed studies) were included. Ten were from the UK, 17 Pakistan, 84 India, 43 Bangladesh, and three a combination of these countries. Despite adoption of the WHO Infant and Young Children Feeding Guidelines (particularly timing and food choice), substantial evidence of non-recommended complementary feeding practices was identified. Factors that affected these practices persisting after migration included bicultural issues or low acculturation levels and conflicting information between health professionals, extended family, and religious and community leaders. By contrast, barriers to enforcement of WHO-recommended complementary feeding practices in South Asian countries included early marriage, conflicts about best use of mother's time, rural life, short birth intervals, and poverty. Interpretation This is the first systematic review, to our knowledge, to study complementary feeding practices across these countries. Similar themes were noted between UK families and countries of origin despite their receiving close National Health Service input from birth (eg, health visitors, general practitioners). This study will inform reverse translation of effective interventions to the UK from their countries of origin to improve complementary feeding practices in these communities. Funding None.