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BACKGROUND: Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties. OBJECTIVE: The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England. METHOD: We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes. RESULTS: We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest “wrong implants” (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 “wrong-site surgery” incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each. CONCLUSION: We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.

Summary Purpose To report glans and penile dimensions in 1023 consecutive boys with hypospadias. Patients & methods Boys admitted for hypospadias surgery between 2016 and 2018 were included in this study. Age ranged between 6 and 36 months. Boys who underwent previous surgery, received hormone therapy or older than 36 months were excluded. The hypospadias was classified according to ICD and WHO classification into glanular (Grade I), distal (Grade II), proximal (Grade III) and perineal (Grade IV). The flaccid penile length (PL), the dorsal glans length (DGL), the ventral glans length (VGL) and the glans width (GW) were measured in the operating room under anaesthesia just before operative correction. Small (GW) in this study was defined as less than 14 mm. Results 1023 boys were included. 273 had glandular, 468 distal, 194 proximal and 88 perineal hypospadias. The mean glans width was 14 mm with a range of 8 to 20 mm. The mean glans width for glanular hypospadias was 14.0 mm (range 9–19 mm), 14.0 mm (range 10–20 mm) for distal hypospadias (p > 0.05), 13.1 mm (range 9–19 mm) for proximal hypospadias (p 0.2), but there was a difference when compared to patients older than 25 months (p Conclusions A small glans is found in about a third of distal, two thirds in proximal and more than 90% of perineal hypospadias. Download : Download high-res image (211KB) Download : Download full-size image Summary Figure . A 9 month old child with proximal hypospadias and 50° penile curvature; A. the Glans Width (GW) was 9 mm. B. The Dorsal Glans Length (DGL) was 9 mm. C. The Ventral Glans Length (VGL) was 4 mm. D. The flaccid Penile Length (PL)was 18 mm.

Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response., Quantitative MRI techniques provide biophysical measures of the microstructural integrity of the CNS. Granziera et al. review the information provided by qMRI in the field of multiple sclerosis research and the potential for translation of qMRI techniques into clinical practice.

Background: Major societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. Methods: Patients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. Results: A total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. Conclusion: A clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications. Résumé: Introduction: Les grandes lignes directrices sociétales recommandent une interruption de cinq jours avant l’intervention chirurgicale du cœur des patients atteints d’un syndrome coronarien aigu qui prennent du clopidogrel. Toutefois, comme il s’agit pour plusieurs d’entre eux de patients de haute acuité, le chirurgien penche vers l’utilisation d’une interruption plus courte. Par conséquent, la présente étude avait pour objectif de déterminer les conséquences de la durée et du moment de la cessation du clopidogrel sur les événements hémorragiques indésirables. Méthodes: La présente étude de cohorte rétrospective portait sur les patients qui avaient subi une intervention chirurgicale au cœur entre 2009 et 2016 dans un centre de soins tertiaires. Nous avons utilisé les modèles multivariés de régression logistique ajustés à l’interruption du clopidogrel, à l’âge, à l’urgence de l’intervention chirurgicale et au type d’intervention chirurgicale pour quantifier les effets des caractéristiques démographiques initiales cliniquement pertinentes sur la fréquence des transfusions massives ainsi que sur les issues des complications hémorragiques. Résultats: Un total de 5 748 patients ont subi une intervention chirurgicale au cœur. Dans cette cohorte, parmi les 1 743 patients (30,3 %) qui avaient reçu du clopidogrel avant l’opération, 884 (50,7 %) avaient cessé le clopidogrel cinq jours avant leur admission à la salle d’opération. L’administration du clopidogrel un à deux jours avant l’intervention chirurgicale (ratio d’incidence approché 1,97; intervalle de confiance [IC] à 95 % : de 1,18 à 3,29) était un prédicteur indépendant des transfusions massives et des complications hémorragiques (ratio d’incidence approché 1,85; [IC] à 95 % : de 1,01 à 3,37). Le groupe de l’interruption de trois à quatre jours n’a pas montré de risque accru de complications hémorragiques graves. Le risque de transfusions massives et de complications hémorragiques a aussi contribué à l’augmentation de l’urgence et de la complexité de l’intervention chirurgicale. Conclusion: Une interruption du clopidogrel de trois à quatre jours avant l’opération n’a pas été associée à un risque accru de complications hémorragiques graves.

Supplemental material, sj-docx-1-urj-10.1177_03915603221150965 for Expression of epidermal growth factor receptor and human epidermal growth factor receptor 2 in urothelial bladder carcinoma in an Egyptian cohort: Clinical implication and prognostic significance by Manal M Sami, Mahmoud H Sherief, Taghrid B El-Abaseri, Ahmed I El-Sakka and Ahmed T El-Serafi in Urologia Journal

In today’s world using data mining and classification is considered to be one of the most important techniques, as today’s world is full of data that is generated by various sources. However, extracting useful knowledge out of this data is the real challenge, and this paper conquers this challenge by using machine learning algorithms to use data for classifiers to draw meaningful results. The aim of this research paper is to design a model to detect diabetes in patients with high accuracy. Therefore, this research paper using five different algorithms for different machine learning classification includes, Decision Tree, Support Vector Machine (SVM), Random Forest, Naive Bayes, and K- Nearest Neighbor (K-NN), the purpose of this approach is to predict diabetes at an early stage. Finally, we have compared the performance of these algorithms, concluding that K-NN algorithm is a better accuracy (81.16%), followed by the Naive Bayes algorithm (76.06%).

Background The COVID-19 pandemic has become a significant public health threat. Therefore, the purpose of this survey was to assess knowledge, attitudes, and precautionary measures related to COVID-19 among college students. Methods A convenient sample of 3263 volunteers responded to a self-administered electronic questionnaire during the period from October to December 2020. The knowledge, attitude, and practice (KAP) score level was calculated with a range of 0–34 points. Results The mean age of the participants was 21 (+/−1.2) years, 69% were female, and 60.3% were urban. The majority of respondents received information about COVID-19 symptoms (93.9%), how to protect yourself (92.5%), and how it is transmitted (86.8%). The most cited sources of information were social media (75.7%), and the most credible were government websites and international organizations. More than half (65%) expressed concern regarding contracting COVID-19, and 89.2% believed that COVID-19 is a dangerous infection due to the rapid spread of the virus. The mean total KAP score was 26.1 (+/−4.2), which differed significantly between gender groups and residential areas. Logistic regression analysis showed that volunteers with good knowledge were 1.3 and 1.0 times more willing to volunteer and maintain a physical distance than those with less knowledge. Female students were 40% less likely to volunteer than males, yet they were 1.8 times more cautious about practicing protective measures such as washing their hands with soap and water than male students. Classifying the COVID-19 pandemic as a serious infection, urban communities have twice been careful to wear masks outdoors and maintain a social distance of at least 2 m from one another compared to rural inhabitants. Conclusion The current survey revealed that medical students have good knowledge regarding COVID-19, a positive attitude towards the use of protective measures, which were necessary to limit the spread of the disease. However, improvement is still required, and community education should occur as usual with a commitment to utilizing all the strategies that can support knowledge to improve and change attitudes as well as practices of the population.

Manygrowth monitoring programmes at health facilities and in communities in Pakistan weigh children with their clothes on. The nutritional status of infants at the Rawalpindi General Hospital was estimated from weight without clothes on and showed that about 8% of malnourished children were being missed. This underestimation mostly affected children with grade II and grade III malnutrition. Generally, more boys have normal nutritional status than girls. Accordingly, weight with clothes on was found to underestimate the malnutrition status of girls more than that of boys. Children should be weighed without clothes on so as estimate their nutritional status and risk accurately

Introduction Regenerative solutions of the skin represent a hope for burn victims with extensive skin loss and chronic wound patients. The development of xeno-free workflow is crucial for clinical application in compliance with the directives of the European Medicines Agency. This study aimed at evaluating the outcome of the xeno-free isolation workflow of keratinocytes from human skin biopsy. Methods Skin biopsies were obtained from volunteers. The epidermis was digested with TrypLE™ Select, which was deactivated by dilution or with trypsin, deactivated by media with fetal bovine serum. Freshly isolated cells were compared for total cell number, viability, activity of caspase 3, gene expression and the presence of the keratinocyte surface markers cytokeratin 14. The cells were cultured in xeno-free conditions for one week and characterized regarding the number and viability as well as the metalloproteinase secretion. Results The number of obtained cells was similar in both workflows. The cell viability was less in the TrypLE group, with slight reduction of the cell surface marker cytokeratin 14. Caspase 3 activity was comparable as well as the gene expression of the apoptotic markers BAX, BCL2 and SLUG, as well as the keratinocyte markers cytokeratin 14, stratifin and filaggrin. Upon culture, the number of keratinocytes, their viability and secretion of matrix metalloproteinases 1 and 10 were equal in both groups. Conclusion This study reports the possibility of isolating functioning and viable keratinocytes through a xeno-free workflow for clinical application., Highlights • The xenofree workflows are essential for clinical application of regenerative medicine. • TrypLE based digestion of skin biopsies can be deactivated by dilution in a xenofree workflow to isolate keratinocytes. • Although the xenofree workflow was efficient, keratinocytes viability was better with the classical trypsin-based workflow. • The cell characteristics were equivalent upon culturing the cells.

We present a case of atypical recurrent optic neuritis. A man in his 50s presented with right optic neuritis and profound visual loss, associated with elevated inflammatory markers. Lymph‐node biopsy was consistent with sarcoidosis. Aquaporin‐4 antibodies were also present. Three months following corticosteroid treatment, his right optic neuritis relapsed, again with raised inflammatory markers. He was started on azathioprine and prednisolone with good effect. A dual diagnosis of sarcoidosis and neuromyelitis optica with aquaporin‐4 antibodies is very rare. Long‐term immunosuppression is required. The case highlights the importance of identifying the features and cause of atypical optic neuritis.

Pollen had a wide range of effects on honey bee. Caged honey bee workers were used to determine the nutritional effects of four main types of pollen collected by honey bee colonies from the study area on the food consumption rates, bees age, the development of the hypopharyngeal (HPG) acini and acid gland (AG) sacs in honey bee workers. Additionally, chemical analysis of the selected pollen types was performed. Pollen diets were as follows: broad bean pollen, date palm pollen, clover pollen, maize pollen and mixture of the for mentioned typrs beside the control pollen diet. The highest mean consumption was observed between 4th and 6th of day aged bees in all diets (23.05 mg./bee/3days). The highest quantity of food consumption was recorded in the 18th day when the workers were fed on date palm pollen (75.42 mg), while the lowest recorded 59.17 mg from maize pollen treatment. The highest mean acinal surface area of HPG was 0.0451mm2, which measured at 9 days-old of bees in all diets. While the workers fed on mixture pollen diet had the highest significant mean recorded the acinal surface area of HPG 0.0450mm2 comparing of 0.0223mm2 in control. The considering increment in average volume of acid gland sac with had been obtained at 18 days-old (0.7276mm3) that resembles the highest significant degree, the greatest mean volume of AG sacs was observed when bees were fed on broad bean pollen (0.6419mm3), while the lowest mean was 0.3643mm3 in control.

Male infertility has a complex etiopathology, which mostly remains elusive. Although research has claimed that oxidative stress (OS) is the most likely underlying mechanism of idiopathic male infertility, the specific treatment of OS-mediated male infertility requires further investigation. Coenzyme Q10 (CoQ10), a vitamin-like substance, has been found in measurable levels in human semen. It exhibits essential metabolic and antioxidant functions, as well as playing a vital role in mitochondrial bioenergetics. Thus, CoQ10 may be a key player in the maintenance of biological redox balance. CoQ10 concentrations in seminal plasma directly correlate with semen parameters, especially sperm count and sperm motility. Seminal CoQ10 concentrations have been shown to be altered in various male infertility states, such as varicocele, asthenozoospermia, and medical or surgical regimens used to treat male infertility. These observations imply that CoQ10 plays an important physiological role in the maintenance and amelioration of semen quality. The present article thereby aimed to review the possible mechanisms through which CoQ10 plays a role in the regulation of male reproductive function, and to concisely discuss its efficacy as an ameliorative agent in restoring semen parameters in male infertility, as well as its impact on OS markers, sperm DNA fragmentation, pregnancy, and assisted reproductive technology outcomes.

Objective: Oxidative stress (OS) plays a key role in the etiology of unexplained male infertility. Coenzyme Q10 (CoQ10) is a potent antioxidant that may improve semen quality and OS in infertile men with idiopathic oligoasthenoteratospermia (OAT), but the underlying mechanism is unknown. Therefore, the present study was undertaken to investigate the effect of CoQ10 on OS markers and sperm DNA damage in infertile patients with idiopathic OAT. Methods: This prospective controlled study included 50 patients with idiopathic OAT and 50 fertile men who served as controls. All patients underwent a comprehensive medical assessment. Patients and controls received 200 mg of oral CoQ10 once daily for 3 months. Semen and blood were collected and analyzed for sperm parameters, seminal CoQ10 levels, reactive oxygen species (ROS) levels, total antioxidant capacity, catalase, sperm DNA fragmentation (SDF), and serum hormonal profile. Results: The administration of CoQ10 to patients with idiopathic OAT significantly improved sperm quality and seminal antioxidant status and significantly reduced total ROS and SDF levels compared to pre-treatment values. Conclusion: CoQ10, at a dose of 200 mg/day for 3 months, may be a potential therapy for infertile patients with idiopathic OAT, as it improved sperm parameters and reduced OS and SDF in these patients.

Objective: To determine the prevalence of Charcot triad, Reynolds pentad, and Tokyo Guidelines criteria and clinical outcomes among patients with cholangitis across different age groups. Patients and Methods: We conducted a retrospective analysis of 257 consecutive hospitalized adult patients with acute cholangitis due to endoscopic retrograde cholangiopancreatography–confirmed choledocholithiasis between January 1, 2015, and December 31, 2019. Patients were divided into 3 age groups: less than 65 years, 65 to 79 years, and 80 years or older. Symptoms, vital signs, and laboratory data on admission were collected. Outcomes included length of hospitalization, intensive care unit stay, and 3-month mortality. Nominal variables were tested with the Pearson χ2 test, and continuous variables were tested with the Wilcoxon rank sum test. Results: Charcot triad decreased with older ages. In the group that was age 80 years or older, malaise was the most common symptom; 33.6% (37 of 110) presented with altered sensorium, 9.1% (10 of 110) had no pain, fever, or jaundice, and positive blood culture results were more frequent. Tokyo cholestasis criterion was present in 96.0% (247 of 257), while inflammation (considered essential for diagnosis) was present in 75.9% (195 of 257). Patients 80 years or older had significantly higher mean length of hospital stay (P

Mitral regurgitation can have varying hemodynamic parameters dependent on factors such as pressure gradients, exercise, and/or provocative maneuvers. We present a case of unusual dynamic mitral regurgitation resolved by coughing in a patient with hypertrophic cardiomyopathy. (Level of Difficulty: Intermediate.), Central Illustration

OBJECTIVE To determine the predictors of postoperative acute kidney injury (AKI) following nonemergent cardiac surgery among patients with variable preoperative estimated glomerular filtration rate (eGFR) levels. METHODS A retrospective study of patients who underwent elective or in-hospital cardiac surgical procedures was performed between January 2006 and November 2015. The procedures included isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), or combined CABG and AVR. The primary outcome AKI (any stage) following nonemergent cardiac surgery utilizing the 2012 Kidney Disease-Improving Global Outcomes (KDIGO) criteria. Patients were categorized based on the following renal outcomes: mild AKI, severe AKI (KDIGO stage 2 or 3), and postoperative dialysis. Patients with G5 preoperative kidney function (including dialysis patients) were excluded. RESULTS A total of 6675 patients were included in our study. The mean age was 66.8 years (SD ± 10.4), with 76.3% being males. A total of 4487 patients had normal or mildly decreased eGFR (G1 or G2) preoperatively (67.2%), while 1960 patients were in the G3 category (29.4%). Only 228 patients (3.4%) had G4 renal function. A total of 1453 (21.7%) patients experienced postoperative AKI. The need for postoperative dialysis occurred in 3.2% of the AKI subgroup. In-hospital mortality was higher among the AKI subgroup (7.2% vs. 0.5%; p

This study aimed to utilize cholesterol conjugation of 5-fluorouracil (5-FUC) and liposomal formulas to enhance the partitioning of 5-FU into low density lipoprotein (LDL) to target hepatocellular carcinoma (HCC). Thus, 5-FU and 5-FUCwere loaded into liposomes. Later, the direct loading and transfer of 5-FU, and 5-FUC from liposomes into LDL were attained. The preparations were characterized in terms of particle size, zeta potential, morphology, entrapment efficiency, and cytotoxicity using the HepG2 cell line. Moreover, the drug deposition into the LDL and liver tissues was investigated. The present results revealed that liposomal preparations have a nanosize range (155 − 194 nm), negative zeta potential (- 0.82 to – 16 mV), entrapment efficiency of 69% for 5-FU, and 66% for 5-FUC. Moreover, LDL particles have a nanosize range (28–49 nm), negative zeta potential (- 17 to −27 mV), and the entrapment efficiency is 11% for 5-FU and 85% for 5-FUC. Furthermore, 5-FUC loaded liposomes displayed a sustained release profile (57%) at 24 h compared to fast release (92%) of 5-FU loaded liposomes. 5-FUC and liposomal formulas enhanced the transfer of 5-FUC into LDL compared to 5-FU. 5-FUC loaded liposomes and LDL have greater cytotoxicity against HepG2 cell lines compared to 5-FU and 5-FUC solutions. Moreover, the deposition of 5-FUC in LDL (26.87ng/mg) and liver tissues (534 ng/gm tissue) was significantly increased 5-FUC liposomes compared to 5-FU (11.7 ng/g tissue) liposomal formulation. In conclusion, 5-FUC is a promising strategy for hepatic targeting of 5-FU through LDL-mediated gateway., Graphical abstract

This study aimed at detecting the effects of COQ10 with and without vitamin E on some semen characteristics of the broiler breeder males. Twenty-five males at 43weeks of age divided into five categories of treatment with five replicates. The first treatment (control group) included drenching with corn oil capsules only. The second and fourth treatments were about drenching with capsules containing the COQ10 enzyme at a concentration of 5 mg / male / day with and without10 mg of vitamin E whereas the third and fifth treatments included drenching with capsules containing the Q10 enzyme at a concentration of 10 mg / male / day with and without 10 mg of vitamin E. This whole scheme of treatments was to study their effects on certain semen and seminal plasma properties. The results showed a significant increase (P

Background Ketamine, a glutamate N-methyl-d-aspartate receptor antagonist, has shown rapid antidepressant effects in treatment-resistant depression. We conducted a systematic review of studies evaluating the efficacy of intravenous ketamine augmentation in treatment-resistant depression patients with bipolar disorder. Methods Major databases were searched for open-label and randomized controlled trials (RCT). Two independent reviewers screened and selected the studies that met the inclusion criteria. Studies were selected following the standard Cochrane methodology, and the findings are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodological quality of the included studies was assessed using standardized measures. Results A total of 1442 articles were screened. Five studies were included in the systematic review (3 RCTs and 2 open-label studies) enrolling 110 subjects (mean age, 45.54 ± 12.65 years; 68.18% female). All the RCTs and open-label studies showed improvement in depressions symptoms after receiving a single infusion of ketamine. Included studies also suggested improvement in suicidal ideation and anhedonia after ketamine infusion. Dissociation and transient increase in blood pressure were the most common reported adverse effects with ketamine. Ketamine infusions did not increase mania symptoms. Conclusions Limited data show efficacy and feasibility of intravenous racemic ketamine in treatment-resistant bipolar depression. Further studies with larger sample size are required to strengthen the evidence.

Purpose The deregulation of the Hippo pathway results in translocation ofYes-associated protein-1 (YAP1) to the nucleus to exert an oncogenic effect. This effect has been demonstrated in several malignancies, yet, in breast cancer (BC), it remains controversial. The present study aimed to investigate the significance of YAP1 expression in BC, its relation to cancer stem cells (CSCs), and the effect of its inhibition on tumor cell survival. Patients and methods We evaluated the expression of YAP1 protein and gene using immunohistochemistry (IHC) and RT-qPCR in FFPE tissue from normal and breast cancer cases. We also studied its association with CSC expression (OCT4, NANOG, and SOX2) and with different clinicopathologic characteristics. Two BC cell lines (MCF7 and MDA-MB-231) were exposed to different concentrations of YAP1 inhibitor "verteporfin" and cell viability was subsequently assessed. Results YAP1 mRNA was higher in BC compared to the normal breast tissue (p-value=0.040) and was higher in luminal tumors compared to triple-negative breast cancer (TNBC) (p-value= 0.017). Its expression in tumors was significantly associated with the expression of pluripotency markers (OCT4 and NANOG) (p-value= 0.030 and 0.035, respectively) and its inhibition resulted in a significant reduction of CSC expression in both MCF-7 and MDA-MB-231 cells. YAP1 nuclear expression by IHC, which signifies its activation, was more evident in invasive carcinomas compared to normal breast tissue and in-situ foci where the expression was limited to the cytoplasm. The pretreatment of BC cells (MCF7 and MDA-MB-231) with YAP1 inhibitor "verteporfin" resulted in their sensitization to the effect of tamoxifen and doxorubicin, respectively, and significantly decreased tumor cell proliferation and survival. Conclusion Our results imply that YAP1 is highly expressed and activated in BC and its inhibition could represent a possible novel therapeutic strategy that should be further explored and investigated to improve the outcome of breast cancer patients.

Background: In this study, we hypothesized that clinically isolated syndrome–optic neuritis patients may have disturbances in neuropsychological functions related to visual processes. Methods: Forty-two patients with optic neuritis within 3 months from onset and 13 healthy controls were assessed at baseline and 6 months with MRI (brain volumes, lesion load, and optic radiation lesion volume) and optical coherence tomography (OCT) (peripapillary retinal nerve fiber layer [RNFL], ganglion cell and inner plexiform layers [GCIPLs], and inner nuclear layer). Patients underwent the brief cognitive assessment for multiple sclerosis, high-contrast and low-contrast letter acuity, and color vision. Results: At baseline, patients had impaired visual function, had GCIPL thinning in both eyes, and performed below the normative average in the visual-related tests: Symbol Digit Modalities Test and Brief Visuospatial Memory Test-Revised (BVMT-R). Over time, improvement in visual function in the affected eye was predicted by baseline GCIPL (P = 0.015), RNFL decreased, and the BVMT-R improved (P = 0.001). Improvement in BVMT-R was associated with improvement in the high-contrast letter acuity of the affected eye (P = 0.03), independently of OCT and MRI metrics. Conclusion: Cognitive testing, assessed binocularly, of visuospatial processing is affected after unilateral optic neuritis and improves over time with visual recovery. This is not related to structural markers of the visual or central nervous system.

Vitamin D (Vit-D), an essential nutrient, interacts with different drugs including chemotherapeutic agents like busulphan, an alkylating agent used for conditioning prior to stem cell transplantation. The correlation between Vit-D plasma levels and busulphan clearance was investigated in an uncontrolled prospective study in patients and mice. Plasma 25(OH)D levels were measured and busulphan pharmacokinetics calculated in 81 patients. Adults received oral busulphan (n = 34) while children received busulphan orally (n = 19) or intravenously (n = 28). Patients received no Vit-D supplementation. To confirm our findings, pharmacokinetics after a single dose of busulphan (oral or intravenous) were evaluated in two groups of mice (n = 60) receiving high or standard-level Vit-D supplementation. Both busulphan clearance (P < 0.0001) and 25(OH)D levels (P = 0.0004) were significantly higher in adults compared to children. A significant negative correlation (P = 0.041) was found between busulphan clearance and 25(OH)D levels in children treated orally. No such correlation was observed in adults or in children receiving intravenous busulphan. In addition, no significant effect of Vit-D levels on busulphan pharmacokinetics in mice regardless of the administration route. In conclusion, 25(OH)D can affect oral busulphan pharmacokinetics in children and its level should be considered when personalizing oral busulphan treatment. Further studies are warranted to confirm the underlying mechanisms.

Objectives: The aim of this work is to evaluate the differentmodalities of post-bariatric breast reshaping in females andtheir aesthetic outcomes and rate of complications.Background: The post-bariatric breast is a real problemafter massive weight loss especially in females. Differentmodalities for the reshaping of post-bariatric breast were used.Patients and Methods: This a prospective cohort studystatistical technique, descriptive statistics as numbers andpercentages were used, conducted over 20 post-bariatric breastpatients requesting breast contouring in the period fromJanuary 2016 to January 2019. Operations were done inMenoufia University and Railways Hospitals. Patient's ageranged from 21-49 years. A total of 20 procedures wereperformed; reduction mammoplasty in 5 patients, auto augmentationin 8 patients, augmentation mastopexy in 5 patients,and implant augmentation in 2 patients.Results: Patient's satisfaction was measured by aestheticrating scale as follow; 1- Very satisfied, 2- Satisfied, 3- Fair,and 4- Dissatisfied regarding improvement in size, shape,and quality of scar. 14 patients were very satisfied (70%), 4patients were satisfied (20%), and 2 patients were fairlysatisfied (10%). And out of the 20 patients, the overall complicationrate was 30%.Conclusion: Breast auto augmentation for breast reshapingin post bariatric patients is an ideal and long life techniquecomparable to other techniques used to address this issue.

Background: Central venous stenosis or occlusion (CVSO) is a major complication in hemodialysis patients that significantly affects morbidity and failure of the peripheral arteriovenous fistula (AVF). However, the best treatment is still unknown (surgical or endovascular). Endovascular treatment is a widely accepted option that includes percutaneous transluminal angioplasty (PTA) with or without stenting. The optimal endovascular treatment is still undetermined. Aim: To study the success rate and effect of endovascular intervention as angioplasty alone or with stenting, in patients with CVSO as optimal endovascular treatment still undetermined. Patients and Methods: this is uncontrolled clinical trial was conducted in Suez Canal University Hospital in the period between July 2017 to July 2019 and follow-up for 12 months. Thirty-four patients with compromised upper limb arteriovenous fistula due to CVSO were included to assess the patency rate of primary angioplasty with or without stenting. Any patients with (mediastinal lesion invading central veins, ipsilateral peripheral vein stenosis, or infected AVF) were excluded. Results: The mean age of studied patients was 53.06±8.49 with a slightly larger number (19) of females (56%). Pre-intervention, the innominate vein was the highest affected with lesion by 41%. Occlusion was in 9 patients (26%), while; 25patients (74%) had stenotic lesion. The success rate of primary patency was 55%, follow-up of the successful cases at 3, 6, and 12 months with patency rate 91%,77%, and 59% respectively. There was no significant difference in the patency rate during one-year follow-up regarding the use of angioplasty alone or with stenting. Conclusion: percutaneous transluminal angioplasty with or without stenting according to our results is successful, safe, and effective in managing central venous lesions in compromised AVF in hemodialysis patients.

Ocimum forskolei (Habak), Lamiaceae, is an endemic species from Yemen and KSA; where our present study was aimed at investigating the Metabolic profiling coupled with LC HR-MS analysis of the dichloromethane fraction from the aerial parts of that plant with a special emphasis on ursolic acid as the major predominating compound from this fraction. Histopathological evaluation of ursolic acid in different doses against indomethacin-induced ulcers in rats revealed a highly significant and dose dependent protection. With the dose level of 50 mg/kg b.w., Ursolic acid gave an ulcer index of 1.33 ± 0.33 and 97.8% inhibition, compared to cimetidine as a standard with 3.0 ± 0.58 and 95.2%. To rationalize this activity, docking on various macromolecular targets was performed, followed by molecular dynamics on the most promising target; the M3 receptor. A high binding energy of -344 kJ/mol is predicted between Ursolic acid and the protein indicating the stability of the predicted pose.

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. Myocardial injury is relatively common in COVID-19, accounting for 7-23% of cases, and is associated with a higher morbidity and mortality. There is a discrepancy in the literature about myocarditis as the etiology of myocardial injury in COVID-19; although many anecdotal reports of myocarditis have been noted, there are only a handful of case reports in the literature about myocarditis related to COVID-19. This review summarizes the most up-to-date literature around the association between COVID-19 and myocarditis and gives clinicians a practical framework about the clinical manifestations, diagnostic tools and treatment options currently available. Importantly, this review will heighten suspicion for myocarditis as an etiology of myocardial injury in COVID-19 patients, therefore improving clinical outcomes and encouraging shared clinical decision-making. This will also open the door for further research to build around this review. Emergent treatment options for COVID-19 are in clinical trials and may be of benefit to COVID-19 patients with myocarditis in addition to current guideline-based recommendations., COVID-19 is responsible for hundreds of thousands of deaths worldwide. Myocarditis as a possible sequela of COVID-19 infection is a likely underestimated cause of mortality and morbidity in critically ill COVID-19 patients. Investigations for suspected myocarditis among COVID-19 patients should include high-sensitivity troponin, ECGs, and echocardiography. Treatment options are currently limited to guideline-directed heart failure therapy, supportive care and/or mechanical circulatory support. Physicians should have a high index of suspicion to ensure a timely diagnosis and subsequent consultation with multidisciplinary subspecialists for ongoing management.

Oxidative stress (OS) is a key contributing factor in 30–80% of male infertility cases. To date, several antioxidant treatments have been put forth to manage OS-induced male infertility. This study intended to elucidate the impact of coenzyme Q10 (CoQ10) and selenium on seminal fluid parameters and antioxidant status in infertile men with idiopathic oligoasthenoteratospermia (OAT). In this prospective study, 70 patients with idiopathic OAT were randomly allocated to receive CoQ10 (200 mg/day) or selenium (200 μg/day) for 3 months. Semen quality parameters (following WHO guidelines, 5th edition), total antioxidant capacity (TAC), catalase (CAT), and superoxide dismutase (SOD) activities were compared before and after the treatment. The results of the study showed an increase in sperm concentration with CoQ10 treatment (p

Obesity and the brain are linked since the brain can control the weight of the body through its neurotransmitters. The aim of the present study was to investigate the effect of high-fat diet (HFD)-induced obesity on brain functioning through the measurement of brain glutamate, dopamine, and serotonin metabolic pools. In the present study, two groups of rats served as subjects. Group 1 was fed a normal diet and named as the lean group. Group 2 was fed an HFD for 4 weeks and named as the obese group. Markers of oxidative stress (malondialdehyde, glutathione, glutathione-s-transferase, and vitamin C), inflammatory cytokines (interleukin [IL]-6 and IL-12), and leptin along with a lipid profile (cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein levels) were measured in the serum. Neurotransmitters dopamine, serotonin, and glutamate were measured in brain tissue. Fecal samples were collected for observing changes in gut flora. In brain tissue, significantly high levels of dopamine and glutamate as well as significantly low levels of serotonin were found in the obese group compared to those in the lean group (P > 0.001) and were discussed in relation to the biochemical profile in the serum. It was also noted that the HFD affected bacterial gut composition in comparison to the control group with gram-positive cocci dominance in the control group compared to obese. The results of the present study confirm that obesity is linked to inflammation, oxidative stress, dyslipidemic processes, and altered brain neurotransmitter levels that can cause obesity-related neuropsychiatric complications.

Cardiac CTA is an indispensable imaging tool for TAVR procedure planning. Post-processing of the dual-energy CT utilizing dual-source and kV-switching approach enables an increase in the density ...

Introduction: Nasal reconstruction is a difficult problembecause it entails reconstruction of skin, cartilage, osseousframe work and lining mucous membrane [1]. The result mustbe satisfactory both cosmetically and functionally [2].The anatomical reconstruction depends on the principleof subunit divisions of the nose. Which states: If the reconstructionis less than the defective subunit the result willappear patchy. On the other hand, if the reconstruction exceedsthe limits of the subunit the nose will appear unnatural [3,4].Local and regional flaps are used in nasal reconstructioneach type has its own advantages, disadvantages and donorsite morbidity [5-9]. The aim of this work is to demonstratethe advantages and disadvantages of expanded forehead flap in nasal reconstruction.Material and Methods: A retrospective review of 25consecutive cases of total or nasal dorsum reconstruction whowere operated upon in a single clinic by 3 separate surgeonsadopting the same principle of expanded forehead flap, betweenJanuary 2010 and January 2017.In this technique the median forehead skin is expandedwith a 200-ml envelope for 6-8 weeks, and then a foreheadflap is incised to match the nasal defect [10].Results: Surgical follow-up varied from a minimum of 6months to a maximum of 2 years with average follow-up of1 year. Among a total of 25 patients, 23 patients (92%)complied with follow-up, and 21 (91%) of these patients weresatisfied. One case only complicated and the expander extrudedand had to be removed.Conclusion: The tint of forehead skin is similar to nasalskin. Forehead flap is well vascularized and is lying adjacentto the nose. Forehead is a multilaminar structure which allowthe usage of skin grafts as inner lining and because of its highvascularity all types of structural support can be used.Expanded forehead flap provides large, excess forehead skinand primary closure of donor site is applicable. During theprocess of expansion, the skin is thinned out so do not needde-fattening and re-contracture do not occur. Therefore,forehead flap is always a good reconstructive option in largenasal defects.