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Rationale: Predicting recovery of consciousness in unresponsive, brain-injured individuals has crucial implications for clinical decision-making. Propofol induces distinctive brain network reconfig...

Introduction: The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). Methods: We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm3 were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. Results: Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm3 and lower PLR ≤18.4 increased the risk of drainage failure (p = 0.009 and 0.001, respectively). Conclusion: Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely-from observation to surgical resection-and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.

Background: Hepatocellular carcinoma is a highly prevalent tumor globally and the world's second leading cause of cancerrelated deaths. Glypican-3, a heparan sulfate proteoglycan expressed on the surface of HCC cells, has emerged as a new molecule with a strong link to occurrence and progression of HCC. Objective: This study was done to determine the role of Glypican-3 in diagnosis of HCC and its prognostic value following different treatment modalities. Patients and methods: The study included thirty patients with liver cirrhosis and HCC on top, and thirty patients with liver cirrhosis without HCC. Standard laboratory investigations, abdominal ultrasound and triphasic computed tomography were done for all patients. Serum alpha fetoprotein and Glypican-3 were measured in all patients before and one month after different treatment modalities. Results: Glypican-3 was significantly higher in HCC group (2.28 ± 0.97) in comparison to cirrhosis group (0.56 ± 0.31) with P-value 1.1 ng/ml Glypican-3 has 93.3% sensitivity, 96.67% specificity, 96.6% PPV and 93.5% NPV for detection of HCC. Conclusion: Glypican-3 can be a valuable diagnostic marker for HCC diagnosis and prognosis after various treatment modalities and may be complementary to alpha fetoprotein increasing overall sensitivity of HCC detection.

Due to the data paucity about the functional outcomes post pyeloplasty for patients diagnosed with ureteropelvic junction obstruction (UPJO) with a preoperative age above the age of 45 years and according to the elderly definition (age ≥ 65 years), we conducted this study to clarify the different outcomes in adults presented with late hydronephrosis. We included patients who were managed by pyeloplasty with a preoperative age ≥ 45 years. We further subdivided those patients into; group (A) patient’s age ≥ 65 years and group (B) patient’s age ≥ 45 and

Radium-223 (Ra-223) has been recommended for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). Second-generation hormone therapy in combination with Ra-223 in mCRPC has been utilized, yet its benefit has not been well elucidated. We investigated the potential survival benefit of concomitant enzalutamide with Ra-223 in the third-line setting and predictors of improved overall survival (OS).We retrospectively identified 51 patients with bone-dominant mCRPC that were treated with Ra-223 in the postchemotherapy and post-hormone therapy setting, either alone (group A; n = 32) or with concomitant enzalutamide (group B; n = 19). The primary endpoint was to study the OS difference between groups A and B. The secondary endpoint was to identify predictors of improved OS with Ra-223 in the third-line setting.Mean age was 70.9 years, median baseline prostatic-specific antigen (PSA) was 23.1 ng/mL, alkaline phosphatase was 91 IU/L, and hemoglobin was 12.5 g/dL. There was no difference in median OS between groups A and B, at 20.4 versus 17.5 months, respectively (P = .5186). In univariate and multivariate analyses, only pre-Ra-223 PSA 30 ng/mL and Eastern Cooperative Oncology Group performance status 2 were associated with improved OS.In our study cohort, concomitant use of enzalutamide with Ra-223 in the mCRPC setting was not associated with improved OS. Only pretreatment PSA 30 ng/mL and pretreatment Eastern Cooperative Oncology Group performance status 2 were associated with improved OS. Further prospective studies are warranted.

Background Preoperative staging of urinary bladder carcinomas using TNM system is crucial in the management of bladder cancer which is determined mainly by stage and grade of tumor at diagnosis. We aim to evaluate the diagnostic accuracy of multiparametric MRI (mp-MRI) for assessment of the bladder cancer T stage and histologic grade. Results The overall T2-WI diagnostic accuracy for the T stage was 72.3%, increased to be 87.1% for contrast-enhanced images, and 92.6% for DWI, reaching the maximum accuracy 94.5% using the combined multi-parametric MRI technique. Diagnostic accuracies of mp-MRI in differentiating superficial from muscle-invasive (91%) and organ-confined from non-organ confined tumors (92%) were superior to DW-MRI (89% and 87%), DCE-MRI (84% and 83%), and T2W-MRI (74% and 71%), respectively. The agreement between MRI findings and histopathological staging was greater in mp-MRI (k = 0.91; excellent agreement) than in DW-MRI (k = 0.77; moderate agreement), DCE-MRI (k = 0.76; substantial agreement), and T2W-MRI (k = 0.53; fair agreement). Conclusion Mp-MRI provides useful information for evaluating the local T stages of bladder cancer and can predict the histological grades of urinary bladder cancers with high diagnostic accuracy.

Introduction Hypospadias is one of the most common anomalies in boys. Many surgical techniques for reconstruction of distal hypospadias have been described, each method having a different success rate. Our objective in this study is the assessment of the surgical technique for repair of distal hypospadias by construction of a neourethra from the augmented urethral plate with two lateral strips of glanular skin, coverage with a dartos flap, and followed by skin closure with preputial skin flap. Material and methods From March 2016 to November 2018, repair of distal hypospadias was performed in 56 children with a mean age of 3.2 years (range 2 to 8 years old). Minimum follow-up was 12 months, maximum up to 24 months. Success was defined by cosmetic appearance of the penis, parent perception of penile appearance, and urinary function. Uroflowmetry was done in 22 children at the 12 months follow-up. Parents evaluation of procedure was done by questionnaire using the pediatric penile perception score (PPPS). Results The results were successful with straight penile shaft, conical glans, slit-like meatus located at the tip of the glans, with no rotation, and normal micturition. Five children had urethrocutaneous fistula (8.9%) that were treated with simple closure. Parents reported 'very satisfactory' (98.2%) and 'satisfactory' (1.8%). Conclusions The described technique of repair of distal hypospadias in children with different variants of urethral plate width and glans size showed good results, both operator's and parent's perception of the results being very satisfactory. This technique is categorised stage 2a in the IDEAL (Idea, Development, Evaluation, Assessment, and Long-term study) staging system for surgical innovations.

OBJECTIVES To assess the long-term functional outcomes after pyeloplasty in solitary kidney (SK) models and to define factors affecting postoperative renal function recoverability in adults. PATIENTS AND METHODS We retrospectively evaluated all adult patients who underwent pyeloplasty for pelvi-ureteric junction obstruction (PUJO) in SK. Long-term renal function was assessed by diuretic scintigraphy and morphological changes were also determined, e.g. renal parenchymal volume (RPV) and parenchymal thickness (PT). We considered a >20% increase in glomerular filtration rate (GFR) as improvement, >20% decrease as deterioration, and changes within 20% as stationary renal function. Univariate and multivariate analysis for factors affecting renal function recoverability, including the Acute Kidney Injury Network (AKIN) Staging System postoperatively, were performed. RESULTS The study included 62 patients with a mean (SD) age of 29 (10.5) years. At a median of 48 months, the mean (SD) GFR increased from 41.3 (17) to 48.5 (20.1) mL/min (P

Adult patients with ureteropelvic junction obstruction (UPJO) would undergo operative pyeloplastyor considered an equivocal type, the decision for management of equivocal UPJOwhether pyeloplasty or watchful follow-up is debatable. Equivocal UPJO referred to findingsand patient’ symptoms suggested an obstruction, whereas the diuretic renogram is not conclusiveto have a decision of pyeloplasty. This study evaluated the smooth muscle arrangement,distribution of collagen fibers, and presence of fibrosis in the UPJ segment in equivocal UPJOand normal UPJ segments using transmission electron microscopy (TEM) methods. The studydesign consisted of 30 adult Egyptian patients who underwent pyeloplasty for unilateral equivocalUPJO. Ten adult patients who had been operated on for oncological indications constitutedthe control group. Ten representative specimens of UPJO and 5 representative specimens of thecontrol group were examined by TEM. Clinical study comprised 30 patients having equivocalUPJO and operated upon with pyeloplasty were followed for 2 years. Retrospectively analysesof records of 42 adult patients who had unilateral equivocal UPJO and were on watchful followup for 2 years was done to compare results of Pyeloplasty to watchful follow-up. Electron microscopystudy of UPJ segment of equivocal UPJO and the normal control cases showed similarfindings with proper arrangement of smooth muscle fibers that were in close contact to eachother, without fibroblast imposed between muscle bundles, and few collagen fibers were found.Clinical evaluation of results of pyeloplasty or watchful follow-up in equivocal UOJO in adultsshowed stable radiological findings, stable split renal function and diuretic renogram. In thewatchful follow-up group 12% of cases required pyeloplasty, indication for pyeloplasty wererepeated urinary tract infection, intolerable recurrent pain. The clinical series supported by ultrastructurefindings showed that watchful follow-up of equivocal UPJO was an accepted treatmentoption.

Extramedullary plasmacytoma (EMP) is one of the rare plasma cell malignancies. It accounts for 3% of all plasma cell tumors and most frequently presented in the aerodigestive tract. EMP may likewise involve the urinary tract, central nervous system (CNS), thyroid, breast, testis, parotid gland, lymph nodes, and skin. Only nine cases of the adrenal EMP were reported in the literature. Whether none of these cases were described to be concomitant with venous thrombus. Herein, we presented a 61-year-old male patient who presented with an incidentally discovered non-functioning right suprarenal mass. Magnetic resonance imaging (MRI) venography showed right non-adenomatous adrenal mass measured 11 × 9.5 × 12 cm. The tumor was associated with venous thrombus extending into the intrahepatic portion of the inferior vena cava (IVC). Bone scan suspected bony hot areas, but skeletal MRI excluded any lytic bony lesions or metastatic deposits. Core biopsy was taken and microscopic examination showed sheets of loosely cohesive malignant small rounded cells; most of them were plasma cells. Immunohistochemical staining was positive for Vimentin, CD-138, and CD-56. The pathological data were revised by two other eminent pathologists, and they confirmed the final pathological diagnosis to be adrenal plasmacytoma. We could conclude that, adrenal EMP is a truly rare entity, it can be associated with venous thrombus. Imaging is helpful in this setting for the identification of associated venous thrombus and to exclude any lytic bone lesions.

Background Adrenal tumors can be detected incidentally in 4 to 8% of patients radiologically. Adenomas, pheochromocytomas, and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rare histopathological findings are uncommon. We aimed to report two rare primary adrenal tumors diagnosed initially as incidentalomas to identify clinical characteristics, management, and clinical outcomes after treatment. Case presentation The first case was a 52-year-old man presented with an incidentally discovered locally advanced primary adrenal angiosarcoma. The patient was managed surgically with no adjuvant therapy. The patient was followed up for 3 years without evidence of local recurrence. The second case was a 63-year-old woman, presented with an incidentally discovered primary diffuse B-cell lymphoma of the left adrenal gland. She was treated by adrenalectomy. Later on, adjuvant six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were given. After 6 months follow-up, the patient was alive and disease-free. Conclusion The diagnosis of adrenal tumors increased nowadays because of the widespread use of imaging studies, though rare pathologies should be taken into consideration.

Objectives: To compare safety and efficacy of bipolar plasmakinetic enucleation of prostate (BPEP) vs holmium laser enucleation of prostate (HoLEP) for management of large benign prostatic hyperpla...

Bladder cancer represents a global health problem. It ranks ninth in worldwide cancer incidence. In Egypt, carcinoma of the bladder is the most prevalent cancer, Bladder cancer has the highest recurrence rate of any malignancy. Certainly, suitable molecular diagnostic markers are required to improve the early detection of bladder cancer and then to prolong survival of patients. The present study was aimed to explore the expression of CDk4 and STAT3 in bladder cancer tissues as prospective for target therapy. Our studied groups showed higher values of CDK4 and STAT3 expression in malignant tissues (SCC andUC collectively) compared to cystitis, however, significantly higher values of CDK4 and STAT3 expression were detected in UC group compared to SCC group. Urothelial carcinomas with papillary patterns showed lower parameters of CDK4 and STAT3 expression compared to the non-papillary variant, with significant differences. Higher grades of UC showed significantly higher parameters of CDK4 and STAT3 expression compared to low grade ones. Muscle invasion increases the level of CDK4 and STAT3 expression parameters, compared to non-muscle invasive UC. Conclusion: Our results showed a good correlation of the expression patterns of both the cell cycle (CDK4) and inflammatory (STAT3) markers studied and might be helpful for suggesting more selective agents in the therapeutic scenario of bladder cancer in the near future. Potential biomarkers such as CDK4 andSTAT3 may be targets for molecular based therapeutic strategies in the prevention or management of bladder cancer. Future studies should explore molecular mechanisms of these proteins to define their roles in tumorigenesis.

Background: Lumbar disc herniation is a localized displacement of disc material beyond the normal margins of the intervertebral disc space and is the most common cause of sciatica. Lumbar microdiscectomy (MD) and open discectomy (OD) are commonly performed surgical procedures for patients with lumbar disc herniation. Objective: The aim of the current work was to compare the benefits and harms of minimally invasive discectomy (MID) versus MD/OD for management of lumbar intervertebral discopathy. Patients and Methods: This cross-sectional study was conducted at Menoufia university hospitals & Al-Haram Specialized Hospital including 36 Patients (with single or double level disc prolapse (L4-L5 or L5-S1) who underwent discectomy using microscopic/or conventional discectomy.Results: In group (1): 75% of the patients had good pain improvement (60 – 90%) and the rest had moderate improvement (40 – 60 %). In group (1) only 30% experienced intermittent pain while the rest have no pain. While in group (2) about 50% had an intermittent pain. There is no significant difference. In group (1) the mean days of hospital stay was (6.10 + 1.6) while in Group (2) the mean days of hospital stay was (1.60 + 0.12). The group (2) has significant short hospital stay length than group (1). Conclusion: It could be concluded that endoscopic approach was associated with similar postoperative pain improvement and frequency and lower operating time, blood loss and hospital stay in comparison to open approaches. We believe that both techniques are safe, and both can be used to lumber disk surgery, but microscopic technique is preferred for its better outcomes.

BACKGROUND Somatostatin receptor (SSTR) PET/CT is utilized with increasing frequency in the clinical treatment of neuroendocrine tumors. Incidental CNS lesions are commonly noted and presumed to be meningiomas, however 68Gallium (Ga-68)-DOTATATE radionuclide use lacks specificity for meningioma identification. Currently there is no established SSTR-based imaging criteria for classification of incidental CNS lesions. METHODS We retrospectively analyzed patients across clinical and radiological databases at Mayo Clinic who had undergone both Ga-68-DOTATATE PET/CT and brain MR imaging who had an incidental CNS lesion identified with clinical or radiographic prediction of meningioma. Known meningioma diagnoses prior to imaging were excluded. Imaging indication, semi-quantitative measures, and corresponding clinical history were analyzed to identify metrics impacting both the predictive and descriptive utility of SSTR-based imaging as compared to corresponding MRI prediction in incidental CNS lesions. RESULTS Among 59 patients with a CNS lesion identified on both imaging modalities, most scans were performed for a history of neuroendocrine tumor (71%). Cases with concordant lesion type prediction of meningioma between imaging modalities (N = 25) displayed a higher median SUV max and Krenning score on Ga-68-DOTATATE PET compared to cases with concordant prediction of other lesions (N=10) or discordant prediction of meningioma (N=24). Ga-68-DOTATATE was more likely to discordantly predict meningioma as compared to the corresponding patient MRI in cases with lower SUV max values. The addition of Qclear technology was significantly associated with diagnostic clarification in cases of imaging discordant tumor type prediction. Prior cranial radiation or use of a somatostatin mimetic did not affect quantitative radiographic measures in lesion characterization, and MRI-based tumor size was similar across groups. CONCLUSION The continued development of SSTR-based imaging biomarker signatures across incidental CNS lesion subtypes will further define the role of this imaging modality in the clinical diagnosis and management of presumed meningiomas.

Adrenal hemorrhage (AH) is a rare condition. It can be traumatic or non-traumatic. Most common causes are septicemia, coagulopathy or bleeding diathesis, and underlying neoplasms. Other reported less common causes of AH are COVID-19 and neonatal stress. Clinical diagnosis of AH is challenging due to its non-specific presentation and occurrence in the setting of acute medical illness. Therefore, most cases are diagnosed incidentally on imaging. Having high clinical suspicion in the proper clinical setting for AH is crucial to avoid life-threatening adrenal insufficiency that occurs in 16–50% of patients with bilateral AH. We discuss the clinical situations that predispose to AH, review the imaging features on different imaging modalities, highlight a variety of clinical cases, imaging features that should be concerning for an underlying neoplasm, and outline the potential role of interventional radiology in management of AH.

OBJECTIVES To compare the mid-term safety and efficacy of holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the management of large-volume benign prostatic hyperplasia. METHODS From December 2016 to March 2018, patients with benign prostatic hyperplasia (≥80 cc) were randomized (block randomization, computer-generated random list) to holmium laser enucleation of the prostate (57 patients) or bipolar transurethral resection of the prostate (55 patients). Patients were excluded if they had an International Prostate Symptom Score 15 mL/s or presence of prostate cancer, bladder stone, urethral stricture, neurogenic bladder, or previous prostate surgery. The primary outcome was hemoglobin loss. The analysis was intention-to-treat. Postoperative findings (36 months) were compared to baseline characteristics. Univariate and logistic regression analyses were performed for risk factors predicting hemoglobin loss or operative time in all patients. RESULTS There was no significant difference in baseline characteristics between the two groups. Holmium laser enucleation of the prostate was associated with significantly better operative time (P = 0.019), operative efficiency (P

To assess clinical presentation and outcomes of different treatment strategies in cases of spontaneous renal hemorrhage (SRH). A retrospective analysis of patients with SRH between 2000 and 2018 was performed. Patients’ demographics, clinical presentation, laboratory and radiological investigations, and different lines of treatment were retrieved. The primary outcome was to assess the predictors of the success of conservative treatment. The secondary outcome was to assess the long-term renal function outcome comparing serum creatinine, e GFF, and CT-assessed renal volume at last follow-up with baseline values. The study included 42 (23 males and 19 women) patients with mean ± SD age was 48.1 ± 17.8 years. Conservative management was successful in 19 (46%) patients. Trans-arterial embolization (TAE) was performed in 13 patients (30%) to control active bleeding. Ten patients (25%) required surgical exploration and nephrectomy. Lower serum creatinine (P = 0.003), higher prothrombin concentration (P = 0.04), lower hematoma size (P = 0.02), and non-AML lesions (P = 0.03) were independent predictors of conservative management success. Unlike the TAE-treated group, serum creatinine increased significantly (P = 0.04) with a significant decrease in e-GFR (P = 0.02) and renal volume (P

Objectives To study risk factors for sepsis and mortality evaluating the role of platelet to leucocytic count ratio (PLR) as a marker for urosepsis and clinical outcomes in cases of emphysematous pyelonephritis (EPN). Materials Patients with EPN were retrospectively reviewed. Patients' age, sex, diabetes mellitus (DM), Body Mass Index (BMI), hydronephrosis, types of EPN, air locules volume, serum creatinine, leucocytic count, and platelet count, PLR, albumin, INR and the line of treatment were analyzed as risk factors of sepsis. Correlation between PLR and other variables was done using Pearson correlation coefficient. Univariate and multivariate analyses for sepsis and mortality were performed. Results Of fifty four patients, 38 patients had SIRS ≥2 criteria on admission. Twenty patients developed sepsis requiring ICU admission. In univariate analysis, male gender, lower BMI, higher INR, higher WBCs count and lower PLR were associated with sepsis (P = 0.0001, 0.009, 0.04, 0.003 and 0.001, respectively). In multivariate analysis, PLR ≤18.4, male sex and BMI ≤24.2 were independent risk factors. Lower PLR directly correlated with serum albumin (P = 0.01) and inversely correlated with serum creatinine and random blood glucose level and Klebsiella infection (P = 0.001, 0.007 and 0.005, respectively). Also, it was correlated with a higher total score of qSOFA and SOFA (P = 0.02 and 0.04). Lower PLR was independent risk factors for death in EPN patients with (P = 0.003). Conclusion EPN is associated with sepsis development. Lower PLR is an independent simple predictor for sepsis and mortality in patients with EPN.

Background:Hepatitis C virus (HCV) infection is a progressive disease that may result in chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Itis estimated that about 160 million individuals are chronically infected with HCV. Hepatocellular carcinoma (HCC), the fifth most common cancer in men and the ninth in women, represents an urgent clinical problem, being the second leading cause of cancer-related death worldwide. Aim of the study: To determine whether VWF is a potential biomarker for liver fibrosis in comparison to other markers of fibrosis and predictor for development of Hepatocellular Carcinoma in comparison with Alpha-feto protein and Des Gamma carboxy prothrombin. Patients and Methods: This study had been carried out on 50 subjects, age range 34-77 year selected from Virology and Hepatology outpatient clinics at Ain shams university hospitals in Cairo after informed consent were taken from the patients. Subjects were divided as follows: Group I: Include 20 HCC patients diagnosed by imaging and alpha- fetoprotein. Group II: Include 20 matched cirrhotic patients without HCC divided according to child – pugh scoring system. Group III: Include 10 apparently healthy subjects, age and sex matched, having no acute or chronic illness and taking no medications were taken as control group. Results: In our study, VW factor was statistically significant higher in cirrhotic patients than control group and in patients with HCC than cirrhotic group without HCC, with weak positive correlation with other markers of liver fibrosis (FIB4, APRI), and weak positive correlation with other markers of hepatocellular carcinoma (alpha feto protein, des gamma carboxy prothrombin). VW factor was statistically significant higher in advanced stages of liver cirrhosis. Conclusion:In conclusion; VWfactor is statistically significant higher in patients with Hepatocellular carcinoma than in cirrhotic patients without HCC. There is weak positive correlation between VW factor as a biomarker for liver fibrosis and other scores assessing stage of fibrosis. There is a strong correlation between VW factor and child score used to classify stage of liver cirrhosis, so VW factor is valuable predictor for hepatocellular carcinoma and advanced stages of liver cirrhosis. Background:Hepatitis C virus (HCV) infection is a progressive disease that may result in chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Itis estimated that about 160 million individuals are chronically infected with HCV. Hepatocellular carcinoma (HCC), the fifth most common cancer in men and the ninth in women, represents an urgent clinical problem, being the second leading cause of cancer-related death worldwide. Aim of the study: To determine whether VWF is a potential biomarker for liver fibrosis in comparison to other markers of fibrosis and predictor for development of Hepatocellular Carcinoma in comparison with Alpha-feto protein and Des Gamma carboxy prothrombin. Patients and Methods: This study had been carried out on 50 subjects, age range 34-77 year selected from Virology and Hepatology outpatient clinics at Ain shams university hospitals in Cairo after informed consent were taken from the patients. Subjects were divided as follows: Group I: Include 20 HCC patients diagnosed by imaging and alpha- fetoprotein. Group II: Include 20 matched cirrhotic patients without HCC divided according to child – pugh scoring system. Group III: Include 10 apparently healthy subjects, age and sex matched, having no acute or chronic illness and taking no medications were taken as control group. Results: In our study, VW factor was statistically significant higher in cirrhotic patients than control group and in patients with HCC than cirrhotic group without HCC, with weak positive correlation with other markers of liver fibrosis (FIB4, APRI), and weak positive correlation with other markers of hepatocellular carcinoma (alpha feto protein, des gamma carboxy prothrombin). VW factor was statistically significant higher in advanced stages of liver cirrhosis. Conclusion:In conclusion; VWfactor is statistically significant higher in patients with Hepatocellular carcinoma than in cirrhotic patients without HCC. There is weak positive correlation between VW factor as a biomarker for liver fibrosis and other scores assessing stage of fibrosis. There is a strong correlation between VW factor and child score used to classify stage of liver cirrhosis, so VW factor is valuable predictor for hepatocellular carcinoma and advanced stages of liver cirrhosis.

To assess long-term clinical and functional outcomes postpyeloplasty in unilateral UPJO in poorly functioning kidneys in exclusive adult population.We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was30% (by diuretic MAG-3 renography). We further subdivided patients into 2 groups; group (A) SRF ≤20% and group (B) SRF20% and30%. Renal function difference was evaluated by the changes in SRF at last follow-up, where 5% change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need of secondary intervention (redo pyeloplasty, nephrectomy, stenting, or endopyelotomy).Among 211 patients. The mean SRF was 20.5 ± 6.6%. After a median follow-up of 67.1 ± 11.8 months, SRF increased significantly to 23.5 ± 7.5 (P.0001). In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (P.0001). Functional success was achieved in 88 (95.6%) patients. Whereas, in group (B), SRF increased from 24.9 ± 3.3 to 27.2 ± 6.3 (P.0001) at last follow-up. Functional success was achieved in 121 (95%) patients. Static SRF in serial follow-up renography had been observed after 12 months of follow-up.Pyeloplasty provides high rates of functional success in poorly functioning kidneys. After 12 months follow-up, SRF seems to be static without deterioration.

Herein, we investigated effect of Thymelaea hirsuta isolates on hepatocellular carcinoma. Methanolic extract of T. hirsuta led to isolation of two new compounds [6` hydroxyDaphnoretin (9) and Mithnin (15)], seven compounds reported for the first time from genus Thymelaea [Dotriacontanol (1), and 3-ketopentatriacontanoic (2), Docosylcoumarate (5), Docosylcaffeate (6), Daphnodorin B (11), 3`` -epi-dihydrodaphnodorin B (12) and Wikstaiwanone B (14)], and six known compounds. Eight compounds (5, 6, 9, 10, 11, 12, 14, and 15) showed significant anti-proliferative activity on HepG2 cells. These compounds caused significant reduction (p

Manual material handling (MMH) is associated with the development of work-related musculoskeletal disorders (MSDs). One-handed carrying is a particularly challenging form of MMH. Age and obesity have been increasing among the general and working populations in the United States and worldwide. While older and obese workers are more susceptible to MSDs in comparison to younger, healthy workers, the effects of one-handed carrying on trunk muscle activity among these populations have not been comprehensively studied. In this paper, we evaluate the effects of age and obesity on trunk muscle activity of six trunk muscle pairs during one-handed carrying of different loads. The results suggest that older and obese individuals do not exhibit considerably larger muscle activity than young and non-obese individuals while carrying a load of approximately 10 kg in one hand for relatively short distances. Accordingly, 10 kg appears to be an acceptable load to be occasionally carried in one hand by older and/or obese individuals from a muscle activity perspective.

Objectives: The radial artery is used as a second arterial conduit in coronary artery bypass surgery. However, concerns exist about the thermal injury incurred to the radial artery during endoscopic harvest. We sought to assess this effect both histologically and radiologically. Methods: From February 2015 to March 2016, 50 consecutive patients undergoing coronary artery bypass surgery utilizing endoscopically harvested radial artery were prospectively studied. Computerized tomography coronary angiography scan was performed randomly in 8 patients who also had their respective radial artery analyzed histologically at the time of harvest. Standard coronary angiography was also performed in 4 additional patients driven by symptoms recurrence. Results: All patients were available for follow up at 1 year following the surgery. There was no mortality during follow-up. Three patients (6%) developed transient complications in the harvest arm which resolved. All radial arteries were patent on follow-up imaging. Histological examination showed integrity of the arterial wall, intact endothelial lining, patent lumens and no significant pathological abnormalities. Conclusion: The use of endoscopic radial artery harvest was associated with few self-limiting morbidities and excellent patency rates. In addition, there was no evidence of any thermal or traumatic injuries sustained to the radial arteries when examined histologically. The use of endoscopically harvested radial arteries appears safe with excellent results.

Background Real-time automated analysis of videos of the microvasculature is an essential step in the development of research protocols and clinical algorithms that incorporate point-of-care microvascular analysis. In response to the call for validation studies of available automated analysis software by the European Society of Intensive Care Medicine, and building on a previous validation study in sheep, we report the first human validation study of AVA 4. Methods Two retrospective perioperative datasets of human microcirculation videos (P1 and P2) and one prospective healthy volunteer dataset (V1) were used in this validation study. Video quality was assessed using the modified Microcirculation Image Quality Selection (MIQS) score. Videos were initially analyzed with (1) AVA software 3.2 by two experienced investigators using the gold standard semi-automated method, followed by an analysis with (2) AVA automated software 4.1. Microvascular variables measured were perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV). Bland–Altman analysis and intraclass correlation coefficients (ICC) were used to measure agreement between the two methods. Each method’s ability to discriminate between microcirculatory states before and after induction of general anesthesia was assessed using paired t-tests. Results Fifty-two videos from P1, 128 videos from P2 and 26 videos from V1 met inclusion criteria for analysis. Correlational analysis and Bland–Altman analysis revealed poor agreement and no correlation between AVA 4.1 and AVA 3.2. Following the induction of general anesthesia, TVD and PVD measured using AVA 3.2 increased significantly for P1 (p p Conclusions AVA 4.1 is not a suitable tool for research or clinical purposes at this time. Future validation studies of automated microvascular flow analysis software should aim to measure the new software’s agreement with the gold standard, its ability to discriminate between clinical states and the quality thresholds at which its performance becomes unacceptable.

Background: The distal radius fracture is the most common fracture seen in an emergency, making up 17% of all fractures. It is complex to treat affected comminuted distal radius fracture. Especially when the fractures are dorsally comminuted, internal fixation via a dorsal approach should be considered. Objective: To evaluate the results of dorsal plating in patients with impacted comminuted distal radius fracture. Patients and methods: This study was done at Al-Azhar University Hospitals, Air-Force military hospital & El-Mattaryah teaching hospital, during the period of December 2019 and December 2020. 13 males and 7 females (20 fractures) aged 22 to 59 (mean 43.2) years underwent fixation of distal radius fracture by dorsal plating with bone grafting. The mode of trauma was high energy mechanism in 11 patients and low energy mechanism in 9 patients. Radiological and clinical outcomes was evaluated. Results: In the outpatient clinic, twenty patients were followed up for evaluation of fracture healing, ROM, hand grip and return to work. The Modified Mayo Wrist Score was 72.5% after at least 6 months follow up. Conclusion: Dorsal plating with bone grafting for impacted distal radius with dorsal comminution allows accurate reduction and maintenance with early mobilization, good function and an early return to work. Keywords: ORIF, Distal radius, Dorsal approach, Intra-articular, Bone grafting.

Background Malignant endobronchial obstruction (MEBO) is the most debilitating complication in non-small cell lung cancer (NSCLC). The therapeutic role of cryotherapy and its impact on survival has not been well addressed. This is to clarify whether the combination of endobronchial cryotherapy (EBCT) and chemoradiotherapy (CRT) improved symptoms, respiratory functions, performance status, and survival outcomes in inoperable NSCLC with symptomatic MEBO compared to that obtained by CRT alone. Results A prospective cohort study included 60 cases presented to Qena University Hospital, Egypt, between December 2016 and May 2019. They were divided into two groups. Group A included 30 patients who were managed with EBCT plus CRT. Group B included 30 patients who were managed with CRT alone. The outcomes assessed were symptoms relief, respiratory function tests (RFT), performance status, and survival outcomes at baseline and 4 weeks of follow-up. Group A patients showed a highly significant improvement in symptoms (cough, dyspnea, and hemoptysis), RFT, 6MWD test, and arterial blood gases, compared to group B. The mean Karnofsky score increased from 57.33±5.67% at baseline to 60.67±6.39% post-EBCT (P=0.036); group A was significantly improved compared to group B (P=0.04). The Kaplan-Meier median survival for all patients was 9.7±0.4 months (95% CI= 8.86–10.54), and group A cases (10.77±0.44 months, 95% CI= 9.9–11.6) was significantly longer than that of group B cases (8.6±0.68 months, 95% CI= 7.3–9.97; T test = 2.631, P=0.011). Conclusion The use of EBCT with CRT for the management of MEBO in symptomatic patients with inoperable NSCLC is an efficient and safe procedure. EBCT improves clinical outcomes, RFT, performance status, and median survival. Trial registration ClinTrial.Gov registration: NCT04710459 on 4/3/2021.

Congenital primary obstructive megaureter (POM) is an uncommon pediatric anomaly that is due to obstructive distal ureter leading to the loss of peristalsis with consequent ureterohydronephrosis causing loss of kidney function. The objectives are to elucidate the etiology of POM by demonstrating the presence of interstitial cells of Cajal (ICC), telocytes, smooth muscles, and collage in the obstructive and dilated ureteral segments. The study was carried out on 15 surgical specimens of congenital POM in pediatric patients, age range was 4 to 24 months, they were operated upon by excision of the obstructed segment, tailoring the dilated ureter, and anastomosing it to the bladder. Specimens included the obstructed ureteral segment and part of the dilated ureter. Specimens were examined with hematoxylin and eosin (H&E) stain, Modified Gomori trichrome stain, immunohistochemistry (IHC) with α-muscle actin, and c-kit (CD117), and transmission electron microscopy (TEM). Obstructed segment showed excess collagen intervening between smooth muscles, excess c-Kit positive cells, and presence of telocytes. The dilated segment of the ureteral wall is formed of smooth muscle bundles with scanty collagen. Staining with c-Kit did not demonstrate positive cells. TEM showed myofibroblasts and close adherence of smooth muscle cells to each other with absence of telocytes. The pathophysiology of POM is multifactorial. Loss of interstitial cells and rarity of collagen result in loss of elasticity of dilated segment leading to massive dilatation. While the obstructed segment had no muscle conductivity due to excess collagen irrespective of presence of telocytes.

The goal of this chapter is to explore the developed computer-aided diagnostic (CAD) system that helps to determine the functionality of renal transplant using diffusion-weighted magnetic resonance imaging (DW-MRI). This study is based on the integration of DW-MRI-based biomarkers with clinical-based biomarkers. The data are acquired at different durations and strengths of the magnetic field (b-values). The DW-MRI data were collected from Egypt and the United States, using different scanners such as GE and Philips. Using a level-set approach, the kidney is first segmented, then estimates the apparent diffusion coefficients (ADCs). Then serum creatinine and creatinine clearance (the clinical biomarkers that we used) are combined with the ADCs, creating new image markers known as integrated ADCs (IADCs). Finally, the IADCs make cumulative distribution functions at the different b-values. Lastly, any classifier may be used to distinguish between nonrejection and acute rejection renal transplant status. More importantly, our proposed CAD system exhibits 93% accuracy, 93% sensitivity, and 92% specificity in distinguishing between the renal transplant status. This concluded that the developed CAD system is completely independent of classifiers, geographical areas, and scanner type. These results support that the developed CAD system might be noninvasively able to assess the status of renal allograft dysfunction.

Drug-induced changes of hair and nails have been observed with a variety of different pharmaceutical agents, both topical and systemic. These compounds or their metabolites may interfere with hair cycling and texture, nail matrix, nail bed, nail folds, and microvasculature. Phototoxic reactions may also occur. Before initiating treatment, physicians and patients should be aware of possible adverse events to hair and nails and should be aware of the preventive measures, if available, as quality of life can be reduced, and adherence and compliance to treatment may be impaired.

Individuals who have suffered a severe brain injury typically require extensive hospitalization in intensive care units (ICUs), where critical treatment decisions are made to maximize their likelihood of recovering consciousness and cognitive function. These treatment decisions can be difficult when the neurological assessment of the patient is limited by unreliable behavioral responses. Reliable objective and quantifiable markers are lacking and there is both (1) a poor understanding of the mechanisms underlying the brain’s ability to reconstitute consciousness and cognition after an injury and (2) the absence of a reliable and clinically feasible method of tracking cognitive recovery in ICU survivors. Our goal is to develop and validate a clinically relevant EEG paradigm that can inform the prognosis of unresponsive, brain-injured patients in the ICU. This protocol describes a study to develop a point-of-care system intended to accurately predict outcomes of unresponsive, brain-injured patients in the ICU. We will recruit 200 continuously-sedated brain-injured patients across five ICUs. Between 24 h and 7 days post-ICU admission, high-density EEG will be recorded from behaviorally unresponsive patients before, during and after a brief cessation of pharmacological sedation. Once patients have reached the waking stage, they will be asked to complete an abridged Cambridge Brain Sciences battery, a web-based series of neurocognitive tests. The test series will be repeated every day during acute admission (ICU, ward), or as often as possible given the constraints of ICU and ward care. Following discharge, patients will continue to complete the same test series on weekly, and then monthly basis, for up to 12 months following injury. Functional outcomes will also be assessed up to 12 months post-injury. We anticipate our findings will lead to an increased ability to identify patients, as soon as possible after their brain injury, who are most likely to survive, and to make accurate predictions about their long-term cognitive and functional outcome. In addition to providing critically needed support for clinical decision-making, this study has the potential to transform our understanding of key functional EEG networks associated with consciousness and cognition.

Background The left ventricle (LV) in obese patients undergoes different patterns of remodeling in order to normalize wall stress. However, little is known about how LV volume indices, LV global longitudinal strain and right ventricular free wall strain (GLS) vary according to the pattern of LV remodeling. Aim To define the echocardiographic reference values of LV volumes and biventricular GLS across the different LV remodeling patterns in obese patients with a preserved ejection fraction. Methods 2393 adult obese patients (1428 females, 965 males) with a normal ejection fraction who underwent echocardiography from January 2008 to December 2018 were selected. They were categorized according to 4 cardiac remodeling groups defined by LV mass index (102g/m2 in males, 88g/m2 in females) and relative ventricular wall thickness (0.42): normal geometry (NG), eccentric hypertrophy (EH), concentric remodeling (CR) and concentric hypertrophy (CH). Obese subjects were further categorized by BMI class (30–35, 35–40, >40 kg/m2). Obese subjects were gender matched to controls with a normal BMI (18.5–25 kg/m2) and normal cardiac geometry. Mean ± SD, One-way Anova and Tukey- Kramer HSD were applied. P Results The mean age of controls and obese patients' were 50±16 and 57±13.6 years respectively (P0.05). Obese subjects with CH had the highest incidence of the cardiovascular risk factors hyperlipidemia, hypertension and history of myocardial infarction or stroke, compared to those with other remodeling patterns (p Conclusion To our knowledge, this is the largest study to define LV volumes and left and right ventricular GLS according to LV remodeling pattern and BMI category. The Lowest GLS was noted in CH. Ejection fraction was similar across the LV remodeling patterns. There were no differences in GLS and LV indexed volumes across BMI categories within each remodeling group. These results can be applied as a reference values for the obese population with a normal LV ejection fraction. Funding Acknowledgement Type of funding source: None

Background Exercise intolerance is the cardinal manifestation of heart failure (HF), yet its underlying mechanism(s) remain poorly understood. Measures of ventricular function such as ejection fraction often have no relationship with exercise capacity in HF. 2D-STE has proved to be more reliable method to evaluate myocardial mechanical function. Our hypothesis is Resistance exercise training (Resist-HFpEF) will improve exercise tolerance and exertional symptoms in patients with HFpEF. Purpose The study aims to evaluate myocardial mechanical function by strain imaging during resistance exercise training in Heart Failure patients with Preserved Ejection Fraction (HFpEF) Methods This is a single centre prospective pilot study. 24 HFpEF patients were enrolled and their baseline comorbidities were recorded. Baseline 2D-STE imaging was performed at rest and during exercise (Visit 1). Patients were then randomized to either a novel resistance exercise training program for 36 sessions (3 sessions per week for 12 weeks) or a standard of care control group. 2D STE imaging was then repeated at follow-up (Visit 2). Peak Global Longitudinal strain (GLS), systolic strain rate (SSR), early diastolic strain rate (SRe) were measured offline. Results Mean age of the Rehab cohort was 68.57±10.52 years and the control cohort was 68.1±6.47 years. 23 study subjects were male (96%). 17% of the study subjects were hypertensive, 63% were diabetic, 42% had NYHA I, 46% had NYHA II and 13% had NYHA III of heart failure. The mean LV ejection fraction in the control and Rehab group after the training program at rest was 61.88±2.26% & 54.74±2.07% (p-value 0.04) and during exercise was 59.90±2.05% and 53.13±2.05% (p-value 0.04). The peak GLS was −18.80±4.29% and −17.7±2.21% in controls during rest and exercise at Visit 1 (p-value 0.27) while the rehab cohort had −18.71±4.7% and −20.82±2.4% respectively (p-value 0.0268). The peak GLS was −17.40±3.05% and −17.96±2.65% in controls during rest and exercise at Visit 2 (p-value 0.3430) while rehab cohort had −17.97±6.21% and −16.57±3.82% respectively (p-value 0.67). (Figure 1a and 1b shows GLS, SRS, SRe at Baseline and after exercise program respectively) Conclusion This pilot study suggest systolic and diastolic reserve can be measured reliably during low grade exercise. These results could reflect improvement in clinical status and exercise tolerance. Figure 1. Comparison of peak GLS, SSR, SRe amongst HFpEF patients at rest and during exercise before and after the rehab training program. Funding Acknowledgement Type of funding source: None

To identify the role of Doppler US (DUS) in the prediction of factors affecting stone-clearance post-SWL for ureteral stones in addition to its role in prediction of pretreatment stone impaction. We prospectively included patients with ureteric stone for SWL between October 2018 and September 2019. Patient’s demographics were collected. Using DUS, resistive index (RI), Δ RI, and ureteric jets were evaluated in both kidneys. Also, stone site, volume, density, skin to stone distance, degree of hydronephrosis, ureteral wall thickness (UWT) were evaluated by NCCT. Univariate and multivariate logistic regression analyses were performed to identify factors that contribute to treatment success. Correlation between ipsilateral RI with other radiological findings predicting stone impaction was done. A total of 93 patients were finally included (61 males and 32 females). The mean age was 31.4 ± 7.7 years. The success rate (absence of significant residuals post 1 month by NCCT) was 51.6%. In multivariate analysis, the presence of ureteric jet, ipsilateral lower RI, and ipsilateral lower UWT were independent factors for treatment success (P = 0.0001, 0.002, and 0.03, respectively). Also, ipsilateral absence of ureteric jet, increased hydronephrosis, and increased UWT were correlated with higher ipsilateral RI in prediction of stone impaction. Ipsilateral higher RI was found to achieve higher accuracy in stone impaction prediction (PPV of 94.8%). Pretreatment DUS is a useful, non-invasive with a less irradiative tool for prediction of stone impaction and stone-free rate post-SWL for ureteric stones.

Solitary fibrous tumors (SFTs) are rare fibroblastic mesenchymal tumors that are usually benign with variable malignant potential. They can develop in any organ due to their spindle cell origin. The exact etiology of solitary fibrous tumors is unknown. The majority of SFTs are benign with 10% to 30% of them exhibiting aggressive and malignant features. The aggressiveness of this type of tumor is not associated with its histological features, which makes surgical resection the treatment of choice. We will review the clinical and radiological features and possible differential diagnoses of SFTs according to their anatomical sites following the World Health Organization 2020 classification.

A systematic review of the literature regarding one-handed load carrying was conducted to identify research gaps for future load carrying studies. Twenty-six articles that may be relevant to elderly and obese people were included. Only two studies evaluated the effect of age as an independent variable during one-handed carrying. Obesity was not included as an independent variable in any of the articles. In general, the results suggested that one-handed carrying is more physically demanding than other methods of load carrying. In many cases, physiological responses to carrying a load in one hand were similar to carrying twice the load equally distributed between two hands. Some studies recommended a one-handed carrying weight limit of approximately 9-10 kg for men and 6-7 kg for women. However, more research on the effects of age and obesity during one-handed carrying is needed to determine if these results hold for elderly and obese people. Practitioner Summary: A systematic review of the scientific literature since 1966 regarding one-handed carrying that may pertain to elderly and/or obese people was performed. Few studies were identified that included aging and none included obesity as independent variables. Areas for future research are identified and discussed.

Obesity is an increasing problem across the globe that has been strongly associated with work-related injury. One-handed carrying is considered one of the most fatiguing methods of load carrying. The objective of this study was to examine the effects of obesity and load magnitude on heart rate and ratings of perceived exertion among young adult males during one-handed carrying. Load magnitude was observed to have a statistically significantly effect on heart rate and perceived exertion of the arm, back and whole body, whereas obesity was significant only for perceived exertion of the arm. The results suggest that young adult obese males can carry similar loads as young adult non-obese males without having a statistically significant increase in heart rate or perceived exertion. However, more research is needed to validate these results for longer distances and carrying times.

Pulmonary artery wedge pressure (PAWP) is often elevated in patients with right-sided congenital heart disease (CHD), raising the possibility of coexisting left-heart disease, but pressure-volume relationships in the left and right sides of the heart influence one another through interdependence, which may be amplified in patients with CHD.We hypothesized that increases in PAWP in patients with CHD would be more strongly related to ventricular interdependence compared with patients who have isolated left-heart disease such as heart failure with preserved ejection fraction (HFpEF). Ventricular interdependence was assessed by the relationship between PAWP and right-atrial pressure (RAP), RAP/PAWP ratio, and the left-ventricular (LV) eccentricity index.PAWP was elevated (≥15 mm Hg) in 49% of patients with CHD (n = 449). There was a very strong correlation between RAP and PAWP in CHD (r = 0.81, P0.001) that greatly exceeded the respective correlation in HFpEF (n = 160; r = 0.58, P0.001; P0.001 between groups). RAP/PAWP ratio and LV eccentricity index were higher in CHD than HFpEF (1.26 ± 0.18 vs 1.05 ± 0.14, P = 0.007) and (0.80 ± 0.21 vs 0.59 ± 0.19, P0.001), respectively. RAP (but not PAWP) was an independent predictor of death/transplant (hazard ratio 1.86 per 5 mm Hg, 95% confidence interval, 1.39-2.45, P = 0.002).Left-heart filling pressures are commonly elevated in right-sided CHD, but this is related predominantly to right-heart failure and enhanced ventricular interdependence rather than left-heart disease. These data provide new insight into the basis of abnormal left-heart hemodynamics in patients with CHD and reinforce the importance of therapeutic interventions targeted to the right heart.

Background:In end-stage patients when all management options have been used, will often develop compromise of their airways as the cancer continues to progress. Endobronchial therapy options may help to relieve some of their symptoms, allowing improvement in their shortness of breath as they go home in combination with other palliative therapies. Objective: To compare the safety; efficacy; and clinical outcome of endobronchialcryotherapy combined with chemotherapy and/ or radiotherapy versus chemo-radiotherapy alone on patients with Non-small cell lung cancer. Patients and method(s): A prospective randomized clinical trial was carried out on 60 patients, diagnosed as bronchogenic carcinoma non-small cell lung cancer type (NSCLC). The patients attended the hospital in the chest department, Qena Faculty of Medicine, South Valley University. Assessment of the patients was done and randomly assigned into two groups.Group1, Include 30 patients subjected to chemotherapy, radiotherapy and endobronchialcryotherapy.Group2 ,Include include 30 patients subjected to chemotherapy and radiotherapy alone. Result(s): There was significant response meat in symptomatology in Group (1) cryotherapy with regard to cough (P value .000) , dyspnea (P value .000) and haemoptysis (P value .000) . Also, from the functional point of view, in group 1 there were significant improvement to cryotherapy was achieved in FVC(P value .000) , FEV1 (P value .000) , PEFR (P value .000) , and 6MWT (P value .000) . However, there were no significant difference in group 2 between the incidence of improvement in FVC , FEV1 , PEFR , and 6MWT. Conclusion:There wasbenifical effect of combination of endobronchialcryotherapy to patients with lung cancer plus chemo and/ or radiotherapy in the form of improved symptoms and lung functions.

BACKGROUND: Twist2 is a transcription factor and an epithelial-to-mesenchymal transition that plays an important role in cell polarity, cell adhesion, and has a role in tumour invasion and metastases.AIM: In this study, we examined the expression of Twist2 in non-muscle invasive bladder carcinoma (NMIBC) and correlated the expression with response to treatment and tumour progression.METHODS: Data of 305 patients with NMIBC of Ta, T1 were retrieved from hospitals archives. Twist2 expression was examined in tissue samples by immunohistochemistry at initial diagnosis and final follow-up, normal control was 10 normal urothelium, 10 patients with muscle-invasive bladder cancer (MIBC) were a positive control. Treatment of NMIBC was implemented according to the European Association of Urology guidelines on NMIBC. The descriptive statistical analysis included means, standard deviation, p-value; Univariate and multivariate Cox regression analyses.RESULTS: Twist2 expression score was identified as negative, low (1-15%); medium (15-40%); and high (40-100%). Patients who had low or low medium scores at the initial diagnosis had a good response and a favourable prognosis. Expression of a high score of Twist2 in patients having high-grade T1 tumours showed non-responsiveness to repeated courses of intravesical bacillus Calmette Guerin (BCG) therapy and was upstaged to MIBC.CONCLUSION: Twist2 expression in tissue samples of NMIBC would indicate the tumour response to therapy, upgrading and upstaging in the follow up after intravesical BCG therapy.

Background: Heart Failure is an epidemic with a current prevalence of over 5.8 million patients in the USA and almost 23 million patients worldwide, with high associated mortality risks. The severe shortage of donor organs for cardiac transplants and increasing number of heart failure patients has led to the increasing popularity of left ventricular assist device (LVAD) therapy for treatment of end-stage heart failure patients. This paper describes our initial clinical experience with LVAD therapy of heart failure patients at our clinic. Methods: Ten patients (eight males and two females) with a mean age of 48 years (range, 14–68 years) were implanted with LVADs as bridge to transplantation (BT) or destination therapy (DT) at our clinic between January 2015 and October 2017. Results: Preliminary results were very promising with 0% 30-day mortality rates and no major surgical complications or LVAD thrombosis. Conclusions: Such results of LVAD implantation in Kuwait indicate the feasibility of establishing De Novo LVAD programs in low volume LVAD centers (≤10 implants/year) with promising results and offer a new era of hope for treating advanced heart failure patients.