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Purpose To compare the effect of the probiotic lozenges and chlorhexidine (CHX) mouthwash on plaque index (PI) , salivary pH and Streptococcus mutans (S. mutans) 3 count among groups of Saudi children. Methods A total of 54 participants aged 8-12 years were randomly allocated into three groups, 18 children in each group. Children in the probiotic group consumed one probiotic lozenge (Biogaia prodentis) daily, while children in the CHX group were instructed to use CHX mouthwash twice daily. The control group was only instructed to follow regular oral hygiene measures. Saliva samples were taken at baseline, 15th and 30th days. PI scores, salivary pH values and S. mutans count were evaluated. Data were statistically analyzed using the ANOVA and the Tukey post-hoc test. Results Probiotic lozenges and CHX mouthwash significantly reduced PI and S. mutans count and increased the salivary pH values. However, there were no statistical differences between the effect of probiotic lozenges and CHX mouthwash on PI (p-value= 800) and pH values (p-value= 0.927) on the 30th day. Conversely a significant difference was reported among their effects on S. mutans count (p-value=0.014) on the 30th day. Greater acceptance and compliance of children to probiotic lozenges were reported. Conclusions Probiotic lozenges could be an alternative to CHX mouthwash and encouraged to be included with the daily oral hygiene measures.

Objectives:To compare the effectiveness of Silver nanoparticles (AgNPs) and Chlorhexidine (CHX) mouthwash onStreptococcus mutans (S. mutans),Lactobacillus spp., andCandida albicans(C. albicans) counts O’Leary plaque index (O’Leary PI) scores, and salivary pH levels among children.Materials and Methods:The study sample consisted of 117 eligible participants aged 12–18 years. They were divided into control, CHX, and AgNPs groups, with 39 subjects per group. The log10salivary microbial counts, O’Leary PI, and salivary pH values were recorded and statistically analyzed at baseline and the 28thday. Descriptive statistics were presented as the mean ± standard deviation. In addition, the analyses of variance (ANOVA) and Tukey posthoc test were implemented. Thep-value ≤ 0.05 denotes a significant difference between the two points.Results:AgNPs and CHX mouthwash were found to have significantly reduced salivary microbial counts and O’Leary PI scores. The salivary pH levels notably increased on the 28thday (p-value < 0.001). All measured outcomes demonstrated notable effects, with the greatest observed for the CHX group, followed by the AgNPs group, and finally, the control group.Conclusion:Chlorhexidine and AgNPs mouthwash effectively reduced the cariogenic microbial count and dental plaque and improved the salivary pH values. AgNPs mouthwash may be used as an adjunctive measure to prevent dental caries.

علم السلامة والصحه هو قديما الامن الصناعي وهو بث الطمانينة وتامين المکان من کافة المخاطر وفي العصر الحديث فقد اتسع التعريف بانه العلم الذي يهتم بالحفاظ علي سلامة وصحة الانسان وذلک بتوفير بيئة خالية من مسببات الحوادث او الاصابات او الامراض المهنية ونتيجة التطور التقني السريع علي الانسان وما يشهده عالمنا المعاصر من تطور في کل مجالات التنمية الاقتصادية والاجتماعية والتعليمية التي تسهم في راحة وطمانينة ورفاهية الفرد اصبح والامن والسلامه قمة احتياجات افراد المجتمع لتحقيق الحماية لهم ولممتلکاتهم واکد علي ضرورة توسعه البحث العلمي في مجال الامن والسلامه داخل المؤسسات التعليمية نظرا لندرة الدراسات في هذا الامر ومدي اهميته ولسيت الاندية الرياضية بصفه عامة واندية المبارزة بصفه خاصة بما تحويه من اقسام مختلفة بعيده عن تلک المخاطر لذلک سعي الباحث لدراسة مدي توافر عناصر الامن والسلامة بأندية المبارزة في مصر ومدي توافقها مع الاتجاهات والتطور العالمي وطبق الباحث تلک الدراسة علي عدد خمسة اندية من اکبر اندية المبارزة بمصر وتوصل الباحث الي عدم ملائمة نظام السلامة والصحة المهنية لما هو مطلوب حيث وجد ان معظم مؤشرات قياس منظومة الامن والسلامة في الاندية عينة البحث لاتنطبق بدرجة کبيرة وهو ما يوجب علينا في ضوء ذلک ضرورة اهتمام مالس الادارة بنظام الامن والسلامة وتعيين جهاز متخصص مسئول عن تحقيق الامن والسلامة وتوفير کل الدعم اللازم لتحيق برنامج الامن والسلامة وما يحتاج من امکانات .

Periapical lesion is the most common sequelae of pulp necrosis due to either carious involvement or trauma. Treatment options to manage periapical lesion with open apex ranges from non-surgical root canal treatment and/or apical surgery to extraction. Objective: clinicall and radiogrphicall evaluation of the effect of MTA and bioceramic root canal sealer to manage immature permenant teeth with open apex. Methodology: The study was composed of sixty teeth from 54 children with age ranged from seven to ten years old age. Children were divided in to two equal groups: 1-Group A:Teeth were received apexification with MTA 2-Group B:Teeth were received apexification with bioceramic root canal sealer. All patients were followed clinically and radiographically immediate postoperatively, 3 and 6 months. Results: The success rate in both bioceramic and MTA was 93.3% and 90% respectively with no statistical significant difference. After 6 months, all teeth shows normal lamina dura among both bio ceramic and MTA groups. While, reduced radiolucences and obvious healing of bone detected among 93.3% and 90% of tooth among bio ceramic and MTA groups respectively. Conclusions: Both MTA and bioceramic sealer show good results

Background: Video endoscopic inguinal lymphadenectomy (VEIL) is a minimally invasive technique that gives superior surgical outcomes than open inguinal lymphadenectomy (IL) for treating lymph node ...

Background: Gastrointestinal stromal tumors (GISTs) are considered the most common mesenchymal tumors in the gastrointestinal tract and the stomach is the most frequently site affected (50–60%). The safety and feasibility of laparoscopic surgery for gastric GISTs of sizes larger than 5 cm remains unclear. It depends on the surgical skills, tumor location and the learning curve of the surgeons. Methods: Between December 2013 and January 2021, thirty patients diagnosed with gastric GISTs underwent laparoscopic partial gastrectomy. This is a retrospective study done in surgical oncology unit, Oncology Center, Mansoura University, Egypt. Results: The most common tumor location was in the greater curvature in (46.7%). The mean tumor size was 7.2 cm (the largest was 13 cm). All of the patients underwent laparoscopic partial gastrectomy. Splenectomy was done for one patient only. The mean operative time was 152.67 minutes and the estimated blood loss (EBL) was 139.33 ml. The mean hospital stay was 3.53 days. The mean follows up period was 32.4 months. Conclusion: Laparoscopic resection for gastric GISTs has become a feasible method. Patients with large tumors have the same favorable outcomes as small tumors. Large-sized GISTs may receive neoadjuvant therapy to downstage the disease and make it amenable for laparoscopic resection.

Performing pedicled TRAM in obese women carries risk of flap loss or native breast envelop necrosis. Our technique depends on performing total flap delay at the same setting with mastectomy with flap suture in situ to be followed 1 week later by flap transfer. This study included 24 operable women who were candidates for skin sparing or modified radical mastectomy. In one case, delay was only done and followed by mastectomy and flap transfer. In later experience, delay plus mastectomy was done first and followed later by flap transfer. Operative data and postoperative complications were recorded. The mean BMI was 37 ± 2.75. The mean total operative time was 200 ± 20.37. The mean total hospital stay was 9.1 ± 3.35 days. The mean total volume of blood loss was 380 ± 82.33 ml. Breast envelop necrosis was encountered in four cases; three of them were replaced by the TRAM skin. There was no total flap loss while partial loss was recorded in five cases. Fat necrosis occurred in eight cases. Most of mastectomy bed and abdominal complications were in average. Most of cases showed satisfactory esthetic outcome. Our new concept of “Interval TRAM” enables safe immediate breast reconstruction with pedicled TRAM in obese women and ensures presence of a skin pack up for the native breast envelop skin. We recommend this technique in every obese female who undergoes skin sparing mastectomy with immediate pedicled TRAM flap reconstruction.

Background. Most of the publications about Laparoscopically harvested omental flap after skin sparing mastectomy were case reports or case series. Most of them were designed for partial breast reconstruction and were lacking long-term follow-up for cosmetic results, oncologic safety, and detailed methodology. Our study aimed at highlighting the place of this method of reconstruction with long-term oncologic safety and cosmetic outcome. Methods. This study included 95 women who were candidates for skin-sparing mastectomy. Those with body mass index below 25 and above 40, those with omental resection or expected marked adhesions were excluded. All patients were consented to then undergo breast reconstruction using pedicled laparoscopically harvested omental flap. Results. The mean BMI was 34. The mean tumor size was 3.4 cm. The mean total operative time was 129 minutes. Inadequate volume occurred in 12 patients (13%). The mean total drainage output was 750 ml with 8.7% incidence of seroma. Partial breast envelop necrosis was encountered in 5 cases. Partial flap loss occurred in 2 patients. Fat necrosis occurred in 11 cases. Mastectomy and abdominal complications were accepted. Local recurrence was met in one patient and distant metastases occurred in 3 cases. 83.7% of patients expressed excellent and good aesthetic outcomes. Conclusion. When skin sparing mastectomy is chosen with suitable body mass index, laparoscopically harvested omental flap is a very safe and attractive option for total breast reconstruction with a minimal donor site morbidity, satisfactory cosmetic outcome with no compromise of the oncologic safety.

In recent years, the decreased efficacy of existing antibiotics toward management of emergent drug-resistant strains has necessitated the search for novel antibiotics from natural products. In this regard, Bacillus sp is well known for producing variety of secondary metabolites of potential use. Therefore, we performed an investigation to isolate and identify Bacillus sp from oral cavity for production of novel antimicrobial compounds. We extracted, purified, and identified a novel bioactive compound by B. megaterium (KC246043.1). The optimal production of compound was observed on de Man Rogosa and Sharpe broth by incubating at 37 °C, and pH 7.0 for 4 days. The bioactive compound was extracted by using n-butanol (2:1 v/v), purified on TLC plates with detection at Rf 7.8 cm; further characterized and identified as a cyclic ploypeptide sharing structural similarity with bacitracin. Minimum inhibitory concentration of bioactive compound was found to be 0.25, 0.5, 1.0, 3.125 and 6.25 μg/ml against Micrococcus luteus ATCC10240, Salmonella typhi ATCC19430, Escherichia coli ATCC35218. Pseudomonas aeruginosa ATCC27853 and Staphylococcus aureus ATCC25923 respectively, with no activity against Candida albicans ATCC10231. Our findings have revealed a novel cyclic peptide compound from B. megaterium with broad spectrum antimicrobial activity against both Gram positive and Gram negative bacteria. Keywords: Antibacterial, Bacillus megaterium, Bacitracin, Drug discovery, Peptide antibiotics

Introduction Endoscopic thyroidectomy (ET) has become a well-established surgical technique that is mainly performed for benign thyroid lesions. Several endoscopic approaches are available, such as transaxillary, unilateral axillo-breast approach (UABA), modified anterior chest wall approach (MACWA), bilateral axillo-breast approach, and most recently the transoral approach and the robotic-assisted techniques. There is no recommended approach, because each approach has its own positive and negative attributes. We, herein, compare between UABA and MACWA in terms of surgical and cosmetic outcomes. Methods This prospective study was conducted from April 2016 to August 2017. Forty patients with unilateral benign thyroid lesions were selected. Of them, 20 patients underwent ET using UABA, and 20 patients underwent ET using MACWA. Gas insufflation was implemented for all patients. Clinicopathologic data, surgical outcomes, and cosmetic outcomes in both groups were analyzed. Results There was no significant difference between both groups in the clinicopathologic characteristics. The mean surgical time was significantly longer in the UABA group compared with the chest wall group (147.3 vs. 124.3 min). The postoperative pain scores were relatively lower in the UABA group compared with the MACWA group. We reported a higher rate of persistent paresthesia, neck contracture with swallowing discomfort, and hypertrophic scars in the MACWA group. Cosmetic satisfaction scores for patients who underwent UABA were higher than for those who underwent MACWA. Conclusions Both approaches were similar in terms of safety, feasibility, and operative complications. Even though the surgical time was longer, patients who underwent the UABA reported relatively less postoperative pain, superior cosmetic results, scar perception, and patient satisfaction compared with MACWA.

Background. Laparoscopic splenectomy (LS) is considered the operation of choice on elective basis for managing patients with certain hematological disorders. Hemostatic control of the splenic pedicle is one of the crucial steps in LS. This study compares the safety and efficacy of using endoscopic staplers and vessel sealing devices to control the splenic pedicle in patients with nonsevere splenomegaly. Methods. Fifty-one consecutive patients with different blood disorders including idiopathic thrombocytopenic purpura (ITP), hypersplenism, and lymphoma were randomized for elective LS. Traditional steps of LS, via lateral approach, were followed, and pedicle control was done with either endovascular gastrointestinal anastomosis stapler (n = 26) or vessel sealing device (Ligasure) (n = 25). Results. No difference was noted with different splenic spans when using either methods of pedicle control ( P = .145). The volume of blood loss was higher in the Ligasure group compared to the staplers group (182 mL vs 131 mL, respectively), but was not statistically significant ( P = .249). Conversion to open was notably higher in the Ligasure group ( P = .034), but the intraoperative complications were comparable in both groups ( P = .357). Conclusion. The use of vessel sealing devices for splenic pedicle control has comparable surgical outcomes compared with the use of endoscopic staplers for LS, but with higher rate of conversion to open surgery.

Low back pain (LBP) is the fifth most common reason for visiting a physician [1, 2]. Although non-traumatic LBP is benign, and self-limited in most cases, it occasionally indicates a serious disease. Emergency physician must able to distinguish between patients with benign non-traumatic LBP requiring merely history taking and physical examination and identify those with LBP indicative of a serious illness. In this article, we have discussed five such cases and have proposed some clinical recommendations to manage nontraumatic LBP to avoid missing the loss of diagnosis of a serious disease.

Objectives: To assess the oral health status and salivary composition in a group of children suffering from bronchial asthma. Materials and Methods: The sample consisted of sixty asthmatic children, sixty healthy negative controls, and sixty healthy positive controls of both sexes with age ranging from 4 to 12 years old. The asthmatics were grouped according to disease severity into mild, moderate, or severe asthmatic. All the children were clinically examined to assess their dental caries experience (decayed, indicated for extraction, and filled primary tooth [def] and decayed-missing-filled permanent tooth [DMF]), dental erosion condition (tooth wear index), and gingival health condition (gingival index [GI]). Salivary samples were collected and assessed for salivary flow rate, salivary pH, and the level of calcium, sodium, and potassium. Results: The results of this study revealed that asthmatic children presented significantly higher def, DMF score, and GI mean values compared to the control groups. Severe asthmatics significantly presented the highest def and GI score. Salivary analysis revealed reduced stimulated salivary flow rate and altered salivary pH. In addition, significantly elevated mean salivary calcium level found to be associated with higher GI mean score. Conclusions: Children suffering from bronchial asthma should receive special dental preventive attention as presented with greater risk for oral and dental diseases as compared to the healthy controls.

Introduction Lactating adenoma is the commonest benign breast lesion seen during pregnancy and puerperium. It is commonly seen in young primigravideous women in the second or third decade during the third trimester of their pregnancy. Occasionally, lactating adenoma is large and rapidly growing and must be differentiated from malignant breast masses that could be seen during pregnancy and lactation. The diagnosis is usually established by cytological and histopathological examination. Case presentation Here we have presented a rare case with huge lactating adenoma arising in the left breast of 38 years old Egyptian multiparous lady during lactation. Enucleation of the mass was done with good aesthetic outcome. Conclusion The case we have presented was unique in its huge size and in being diagnosed in a multiparous lady and furthermore it was successfully treated by enucleation without any need for reconstruction.

Purpose: To evaluate the association between dental caries and body mass index (BMI) among a sample of male primary school children in Makkah city, Saudi Arabia.Population and Methods: This is a cross-sectional study carried out on a sample of 548 6-12-years-old children in Makkah City, western region of Saudi Arabia. Cluster random sampling technique was applied to select students from public as well as private schools. All the subjects were examined by a single operator using a dmft (decayed, missing, filled primary teeth) and DMFT (decayed, missing, filled, permanent teeth) indices and BMI after obtaining the informed consent.Results: The study included children with mean age 9.5±1.8 years. Of the examined children, 91.2 % had dental caries. Obese children represented 16.8% of the participants whereas underweight represented 11.6% of them. Caries prevalence in primary and permanent teeth among caries-affected children was 67.60% and 86.40% respectively. Underweight children exhibited the highest prevalence and severity of dental caries in both primary and permanent teeth. Correlation analysis showed significant negative relations with BMI, dmft [r = -0.627, p< 0.01] and DMFT [r = -0.205, p< 0.01].Conclusions: Most of 6-12-years-old primary school children in Makkah had dental caries in both primary and permanent teeth. Underweight children were more likely to have dental caries in both primary and permanent teeth compared to children with other BMI categories.

Objective To compare between manual and rotary protaper filing techniques in partially pulpectomized primary molars from microbiological point of view. Materials and methods This study was performed on 60 badly decayed primary molars indicated for partial pulpectomy. Molars were selected from children attending the outpatient clinic of Pedodontics and Oral Health Department, Faculty of Dental Medicine, Al-Azhar University. The selected teeth were classified into two equal groups. GP 1: 30 primary molars were received partial pulpectomy using manual protaper filing system. GP 2: 30 primary molars were received partial pulpectomy using rotary protaper filing system. Microbiological assessment for the canal preparation were done after collection of initial and postfiling samples for each group. Results Rotary group offers highest percent of bacterial reduction when compared with manual group with statistically significant differences. Conclusion Rotary protaper instrumentation was more effective in reducing bacterial numbers in infected root canal than manual instrumentation. Both filing techniques did not give bacteria-free canal.

Background: Minimally invasive esophagectomy nowadays is replacing the classic open technique. Additional studies are needed to confirm its safety and efficacy. Methods: thirty patients with esophageal carcinoma were enrolled in this study. Patients were evaluated preoperatively and they underwent thoracoscopic and laparoscopic procedures for assessment of resectability. Resectablepatients underwent radical esophagectomy with gastric tube reconstruction through a four-cm neck incision. Results: 17 patients were operable and 13 patients were inoperable. The mean operative time for the whole procedure was 5.97 ± 1.66 hours. The mean blood loss was 250 ± 138.07 cc. The mean overall hospital stay was 17.47 ± 5.49 daysdays. Common postoperative complications included pneumonia (13.3%) pleural effusion (6.7%), cervical anastomotic leakage (10%), and wound infection (13.3%). One patient died in the early postoperative period. Conclusions: we conclude that totallyendoscopic (thoracoscopic and laparoscopic) esophagectomy is feasible and relatively safe technique. Beside its efficacy as an assessment tool, total esophagectomy and lymphadenectomy could be performed in the same time.

The study compares prospectively the hospital stay and postoperative complications of anterior (ALS) versus lateral (LLS) approach for laparoscopic splenectomy.Between September 2011 and April 2015, 94 patients with splenomegaly were referred to the surgical unit in the Oncology Center of Mansoura University, Egypt. Only 80 patients with splenomegaly30 cm underwent an open-label randomized allocation into 2 equal parallel groups. Indications were hematological in 52 patients (65%) and malignant splenic conditions in 28 patients (35%). Two patients younger than 18 years, 4 patients with splenomegaly30 cm, and 8 patients with associated surgical comorbidities were excluded. Three days' hospital stay reduction with LLS was suggested with a power of 80% and P-value of 0.05.The mean hospital stay was significantly shorter (P=0.001) after LLS. Laparoscopic splenectomy was completed in 68 patients (85%). Twelve patients (15%) required open splenectomy with no difference between groups. The operation time was significantly shorter in LLS (P=0.013). Blood loss (P=0.057) and blood transfusion (P=0.376) showed no difference between the two groups. The times until resumption of oral intake (P=0.019) and drain removal (P=0.011) were statistically shorter in LLS.LLS is more safe and feasible with shorter hospital stay compared with ALS.

The surgical treatments of hepatocellular carcinoma (HCC) in a cirrhotic liver include both hepatic resection and liver transplant. While the liver transplant is considered as a golden therapy, it has some obstacles including shortage of organs especially living donors, economic circumstances, and the progression of a tumor while waiting for the transplant so the second choice which is resection should have a role. In this study, 84 patients with HCC (who were legible for transplant according to Milan and extended selection criteria) were enrolled for hepatic resection. The outcome including complication and the oncologic outcome was evaluated. We followed our patients for 15 months as a median follow-up (range from 3 to 50 months); we noticed 10 tumor relapse (11.7%) and seven lost (8.3%). We also noticed no recurrence. Patients’ overall survival showed a median of 15 and 50 months, respectively. We can conclude that there is reasonability for HR as an effective optional treatment for patients with HCC who are legible for transplant particularly for patients with a Child-A scoring.

Introduction Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that is confused with cancer. It usually affects women in child bearing age. The exact aetiology and pathogenesis are still unknown, and the optimal therapeutic modality has not yet been established. Treatment most frequently includes Antibiotics, corticosteroids and immunosuppressant, surgical excision, and even mastectomy. Material and methods We studied a thirty cases diagnosed with IGM in our locality to find out the leading risk factors and the outcome of our surgical approach which involves excision of the lesion in continuity with duct system. Patients demographic data, history related to lactation and outcome were recorded. Results All patients were parous women with history of previous breast feeding for all kids. Twenty-six patients (86.66%) had a history of early incomplete nursing care to the affected breast. After our surgical approach, Twenty eight (93.3%) patients showed fast recovery with no detectable recurrences in the median follow up period (18 months) with acceptable cosmoses. Conclusion History of breast feeding together with early failure of complete nursing from a single breast is the most important risk factors for development of IGM in young aged women. Surgery plays an important role in treating IGM, however, it should be directed towards excision of the present mass (s) together with the pathological and colonized duct system.

Al-Khadoud spring is one of the most important water resources in Al-Hassa Governorate, Saudi Arabia. However, much of its biotic information is still unknown. This study presented preliminary ecological information of this aquatic body. Regarding to macrophytes, a total of eight species were observed along the study sites. These species include two submerged aquatic plants (Potamogeton pectinatus L. and Ceratophyllum demersum L.). The common distributed species are Phragmites australis (Cav.) Trimex Steud and Cyperus rotundus (L.). On the other hand, a total of 20 algal genera were recorded with 7 genera of Chlorophyceae, 8 of Bacillariophyceae, 4 of Cyanophyceae and one of Euglenophyceae. The common phytoplankton occurred in all three investigated sites were Chlorella vulgaris, Mougeotia sp., Oscillatoria sp. and Actinastrum sp. Regarding to the biotic fauna, different forms of unicellular zooplankton such as Paramecium and Amoeba were recorded. Invertebrates such as freshwater insects and some freshwater snails were documented in the study sites including Melanodies tuberculata, Melanopsis praemorsa and Lymnaea auricularia. As regard to vertebrates, one species of fish, Aphanius dispar, dominate the spring basin and its extended channels.

The surgical treatment of bladder cancer is the curative treatment especially in early cases. In this study, our aim was to assess the outcome of preservation of internal genital organs in selected females both oncologically and functionally, and to assess the feasibility of technique and its complication. 24 females with clinically and radiologically diagnosed T2 bladder cancer underwent gynecologic-tract sparing cystectomy (GTSC). Age ranged from 45 to 60 years. Patients with diffuse carcinoma-in-situ, those with tumors involving the bladder neck, those with poor general condition and those with preoperative incontinence were excluded. 1 patient, who developed local recurrence after 6 months. One patient lost follow up after 15 months. No recurrence developed in the retained genital organs. The remaining 20 patients remained free of disease. Among women who were eligible for functional evaluation, Daytime and nighttime continence were satisfactory in 21/22 (95.4 %) and in 20/22 (90.9 %) respectively. Chronic urinary retention, pouch-vaginal fistula was not noted. Most of patients showed superior Sexual Function index. Cystectomy with preservation of the internal genital organs is feasible in female with early, solitary or T2 bladder cancer with satisfactory functional and oncologic outcomes with proper case selection.

Sameh Roshdy,1 Osama Hussein,1 Ashraf Khater,1 Mohammad Zuhdy,1 Hend A El-Hadaad,2 Omar Farouk,1 Ahmad Senbel,1 Adel Fathi,1 Emadeldeen Hamed,1 Adel Denewer1 1Department of Surgical Oncology, Mansoura Oncology Center, 2Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Although therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. Methods: The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. Results: Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. Conclusion: TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations. Keywords: therapeutic mammoplasty, medial pedicle, breast cancer, mastectomy

In the last years with according to the increasing application of wireless sensor networks in military, space, medicine, safety, fields and etc, many methods and algorithms have been represented to improve the quality of routing. But according to existence limits in this network, the representative methods aren't properly responsible and the goals should be improved. Our goal is that we should prepare a soft QoS for different packets that the data on route will be not available easily in wireless networks. In wireless network, it has been worked a lot about reliability, delay and energy but in this network the energy problem is the main goal and also must be work it. In this paper determining the route unlike many of papers is based on the node's local information and links.

Background Traditionally, conservative breast surgery was contraindicated in centrally located breast tumors, with total mastectomy as the treatment of choice. However, restorations of the central defects by the oncoplastic volume displacement or replacement techniques have been shown to be effective. The aim of the current study was to assess the surgical outcome of oncoplastic techniques after central breast tumors resection. Methods Thirty patients with central breast cancer, including two patients with Paget disease, treated at the Oncology Center of Mansoura University (Egypt) between June 2011 and December 2014 were included in this study. The oncoplastic techniques performed were Grisotti advancement rotational flap in eight (26.7 %) patients, classic skin-sparing mastectomy (SSM) with latissimus dorsi pedicled flap in 20 (66.7 %) patients, and skin-reducing mastectomy (SRM) with latissimus dorsi pedicled flap using wise pattern inverted T incision in two (6.7 %) patients. The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree. Results The median age was 40.5 years (range; 23–55). There were no major complications that require repeating the oncoplastic techniques. Recorded complications included wound dehiscence (4/30, 13.3 %) donor site seroma (4/30, 13.3 %), and surgical site infection (1/30, 3.3 %). The 6-month subjective patient satisfaction was excellent in 21 (70 %) patients, good in 6 (20 %) patients, and fair in 3 (10 %) patients. There was no episode of local recurrence or systemic metastasis after an average follow-up duration of 24 months (range; 6–42). Conclusions Restoring the central defect after resection of the central breast tumors can be safely achieved using oncoplastic procedures including the Grisotti technique or the design of SSM or SRM with immediate breast reconstruction. In our patients, these procedures yield a satisfactory esthetic outcome with lower morbidity.