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Introduction: In critically ill patients, transfusion‐related acute lung injury (TRALI) remains the leading cause of transfusion‐related fatalities in critical care settings and is associated with inflammation and oxidative stress state. Recent research raised the potential efficacy of high‐dose intravenous ascorbic acid (VC) in critically ill patients. Objective: The aim of this trial was to investigate the effect of high‐dose intravenous VC as a targeted therapy for TRALI in terms of serum proinflammatory (interleukin [IL]‐8, IL‐1β, C‐reactive protein), anti‐inflammatory (IL‐10), oxidative stress (superoxide dismutase, malondialdehyde) markers, and plasma VC levels. Secondary outcomes were oxygenation (PaO2/FiO2 ratio), vasopressor use, duration of mechanical ventilation, ICU length of stay, 7‐day mortality and 28‐day mortality. Methods: Eighty critically ill patients with TRALI (n = 80) were randomized to receive 2.5 g/6 h intravenous vitamin C for 96 hours (ASTRALI group) or placebo. Patients were followed up to measure the outcomes initially (T0) and at the end of treatment (T96). Results: When compared to the control group, the ASTRALI group at T96 showed significantly higher median of IL‐10 (31.6 ± 25.8 vs 17.7 ± 12.0 pg/mL, P <.0001) levels and superoxide dismutase (12 876 ± 4627 U/L vs 5895 ± 6632 U/L, P <.0001) activities, and lower median C‐reactive protein (76 ± 50 vs 89 ± 56 mg/L, P =.033), IL‐8 (11.8 ± 7.3 vs 35.5 ± 19.8 pg/mL, P <.0001) and malondialdehyde (0.197 ± 0.034 vs 0.234 ± 0.074 μM/L, P =.002) levels. Conclusion: High‐dose ascorbic acid was associated with significantly reduced oxidative stress, reduced pro‐inflammatory markers except IL‐1β, elevated anti‐inflammatory marker and elevated plasma VC levels. [ABSTRACT FROM AUTHOR]

Purpose. To assess the safety and stability in cases of small incision lenticule extraction with collagen cross-linking (SMILE Xtra). Methods. This study was a retrospective interventional comparative study that included 60 eyes of 30 patients divided equally into two groups: SMILE Xtra and SMILE alone. The inclusion criteria were patients >18 years of age, myopic error >6 D, thinner cornea <520 microns, and abnormal corneal topography. Outcome data were recorded including uncorrected distance visual acuity and corrected distance visual acuity (UDVA and CDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness, average keratometry, endothelial cell density, corneal resistance factor (CRF), and corneal densitometry. The follow-up period was 24 months. Results. There was a significant difference between the 2 groups regarding UDVA, CDVA, and MRSE at 1 month. In the SMILE Xtra group, 90% of eyes had postoperative UDVA of 20/20 and 97% had UDVA of 20/30 at 24 months. At 24 months, 26 eyes (87%) vs. 25 eyes (84%) were within ±0.50 D of attempted correction in SMILE Xtra and SMILE groups, respectively. Regarding stability, both groups showed improvement of MRSE at 1st month postoperatively and remained stable along the 24 months of follow-up. CRF and corneal densitometry were higher in the SMILE Xtra group along the whole follow-up period (p=0.001). Conclusion. Combining corneal cross-linking with SMILE procedure (SMILE Xtra) is a promising tool to prevent ectasia in high-risk patients. It is a safe and simple procedure that can be offered to patients undergoing SMILE with risk for ectasia. Trial registration no: PACTR201810577524718. [ABSTRACT FROM AUTHOR]

Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA) presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present) were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair) as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres. [ABSTRACT FROM AUTHOR]

An infertility problem is a complex issue that affects 15% approximately of couples worldwide. The current study was designed to evaluate if there is a variation in the status of global DNA methylation among the study groups and to assess their impact on the protamine expression level and human semen parameters. Totalling 200 semen samples were collected from men (50 proved fertile, 60 normospermia and 90 oligospermia) with an average age of 34.9 ± 4.3 years. The DNA and RNA were isolated from purified spermatozoa; then, ELISA and qPCR were applied to estimate the status of global sperm DNA methylation and protamine expression level respectively. Besides that, the sperm chromatin decondensation and sperm DNA fragmentation were assessed. A significant variation was found in the global sperm DNA methylation and the protamine 1 and protamine 2 expression level among the study groups (p ≤.001). Down‐regulation has been found in the protamine 1 and protamine 2 expression levels in the oligospermia group compared to the proved fertile group with fold change (0.001 and 0.0002 respectively). In conclusion, this study proposes that the alteration in global DNA methylation may influence the protamine expression level and may be lead to abnormalities in human semen parameters. [ABSTRACT FROM AUTHOR]